Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China.
J Bone Joint Surg Am. 2021 Aug 18;103(16):1510-1520. doi: 10.2106/JBJS.20.00569.
Few investigations of venous tumor thrombus (VTT) in primary pelvic bone sarcomas are available. We aimed to identify the prevalence, associated factors, and prognosis of VTT across different types of pelvic sarcomas and to propose an algorithm for management.
We included 451 consecutive cases of primary, bone-derived, treatment-naive, pelvic sarcomas in this study. Demographic data and the results of initial laboratory tests, imaging examinations, and oncological evaluations were extracted and analyzed. Forty-four cases of VTT were diagnosed with radiographic examinations, and 18 of them were verified histologically.
The cohort consisted of chondrosarcomas (41.2%), osteosarcomas (30.4%), Ewing sarcomas (15.5%), bone-derived undifferentiated pleomorphic sarcomas (5.8%), and other bone sarcomas (7.1%). The prevalence of VTT was 9.8% in the whole group, and associated factors included a lactate dehydrogenase (LDH) level of ≥230.5 U/L and invasion of the L5-S1 intervertebral foramen. Patients with pelvic osteosarcoma had a high prevalence of VTT (22.6%), and the associated factors in this group included a chondroblastic subtype, an LDH level of ≥187 U/L, and invasion of the obturator foramen and the L5-S1 intervertebral foramen. Patients with VTT had a poor prognosis with a median overall survival time of 14 months. Subgroup analyses of localized pelvic osteosarcoma indicated that the presence of VTT decreased the median overall survival time (21.5 versus 54.0 months for those without VTT, p = 0.003), median recurrence-free survival time (18.6 versus 32.4 months, p = 0.020), and median metastasis-free survival time (11.2 versus 41.0 months, p < 0.001).
VTT is most common in patients with pelvic osteosarcoma as compared with patients with other primary bone sarcomas, and it is associated with several factors. It is a negative prognostic factor. An algorithm for management of pelvic sarcomas with VTT stratified by the classification of the VTT might be beneficial, but further validation is necessary.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
原发性骨盆骨肉瘤中静脉肿瘤血栓（VTT）的研究较少。我们旨在确定不同类型骨盆肉瘤中 VTT 的发生率、相关因素和预后，并提出一种管理算法。
本研究纳入了 451 例原发性、骨源性、未经治疗的骨盆肉瘤患者。提取并分析了患者的人口统计学数据以及初始实验室检查、影像学检查和肿瘤学评估的结果。通过影像学检查诊断出 44 例 VTT，其中 18 例经组织学验证。
该队列包括软骨肉瘤（41.2%）、骨肉瘤（30.4%）、尤文肉瘤（15.5%）、骨源性未分化多形性肉瘤（5.8%）和其他骨肉瘤（7.1%）。VTT 的总发生率为 9.8%，相关因素包括乳酸脱氢酶（LDH）水平≥230.5 U/L 和 L5-S1 椎间孔侵犯。骨盆骨肉瘤患者 VTT 发生率较高（22.6%），该组的相关因素包括成软骨亚型、LDH 水平≥187 U/L 以及闭孔和 L5-S1 椎间孔侵犯。患有 VTT 的患者预后较差，总生存时间中位数为 14 个月。局限性骨盆骨肉瘤的亚组分析表明，VTT 的存在降低了总生存时间（VTT 患者为 21.5 个月，无 VTT 患者为 54.0 个月，p=0.003）、无复发生存时间中位数（VTT 患者为 18.6 个月，无 VTT 患者为 32.4 个月，p=0.020）和无转移生存时间中位数（VTT 患者为 11.2 个月，无 VTT 患者为 41.0 个月，p<0.001）。
与其他原发性骨肉瘤相比，VTT 最常见于骨盆骨肉瘤患者，且与多种因素相关。VTT 是一个预后不良的因素。根据 VTT 的分类对 VTT 合并骨盆肉瘤患者进行分层的管理算法可能有益，但需要进一步验证。
预后 IV 级。有关证据水平的完整描述，请参见作者说明。
