Department of Orthopedic and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Department of Anatomical Pathology Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Int J Surg Oncol. 2021 Apr 26;2021:8843325. doi: 10.1155/2021/8843325. eCollection 2021.
Multimodality treatment, incorporating neoadjuvant chemotherapy and adjuvant chemotherapy, is the standard management plan for osteosarcoma that increases the overall survival (OS) rate. However, data regarding prognostic factors affecting the histopathological response following neoadjuvant chemotherapy is limited. We retrospectively reviewed patients diagnosed with osteosarcoma in our center between 2008 and 2018. We classified patient characteristics according to gender, age, tumor size, site and stage at diagnosis, site of metastasis, type of surgery, necrosis rate based on the Huvos grading system, and the number of neoadjuvant chemotherapy cycles. We divided response to neoadjuvant chemotherapy into poor responder for patients with Huvos grades 1 and 2 and good responder for patients with Huvos grades 3 and 4. We also documented patients' survival and follow-up information.
We reviewed 64 patients within 5-65 years of age, dominated by men (62.5%). The distal femur (53.1%) was the most common site of osteosarcoma. Fifteen (23.4%) patients had a good response while 49 (76.6%) patients were poor responders to neoadjuvant chemotherapy based on the Huvos grading system. Based on multivariate analysis, gender ( = 0.012), age ( = 0.029), symptom duration ( = 0.004), and tumor enlargement after neoadjuvant chemotherapy ( < 0.001) were significantly associated with histopathological response. A scoring system was proposed integrating these significant variables (age > 20 years = 1 point, female gender = 1 point, symptom duration > 12 weeks = 1 point, and increased tumor size after neoadjuvant chemotherapy = 2 points). This scoring system divides patients into two groups with a total score of more than two predicting a poor responder to neoadjuvant chemotherapy.
Age, gender, symptoms duration, and tumor size after neoadjuvant chemotherapy are the prognostic features that affect the histopathological response to neoadjuvant chemotherapy in patients with osteosarcoma.
新辅助化疗联合辅助化疗的多模态治疗是提高骨肉瘤总生存率（OS）的标准治疗方案。然而，关于影响新辅助化疗后组织病理学反应的预后因素的数据有限。我们回顾性分析了 2008 年至 2018 年在我院诊断为骨肉瘤的患者。根据性别、年龄、肿瘤大小、诊断时的部位和分期、转移部位、手术类型、Huvos 分级系统的坏死率以及新辅助化疗周期数对患者特征进行分类。我们将新辅助化疗的反应分为 Huvos 分级 1 和 2 的差反应者和 Huvos 分级 3 和 4 的好反应者。我们还记录了患者的生存和随访信息。
我们回顾了 64 名年龄在 5-65 岁之间的患者，其中男性占 62.5%。股骨远端（53.1%）是骨肉瘤最常见的部位。根据 Huvos 分级系统，15 名（23.4%）患者有良好的反应，而 49 名（76.6%）患者为新辅助化疗的差反应者。多因素分析显示，性别（ = 0.012）、年龄（ = 0.029）、症状持续时间（ = 0.004）和新辅助化疗后肿瘤增大（ < 0.001）与组织病理学反应显著相关。提出了一个整合这些显著变量的评分系统（年龄>20 岁=1 分，女性=1 分，症状持续时间>12 周=1 分，新辅助化疗后肿瘤增大=2 分）。该评分系统将患者分为两组，总分超过 2 分的患者预测为新辅助化疗的差反应者。
年龄、性别、症状持续时间和新辅助化疗后肿瘤大小是影响骨肉瘤患者新辅助化疗后组织病理学反应的预后特征。
