Department of Oncology, Hôpital La Timone, Marseille, France.
Institut Gustave Roussy, Villejuif, France.
Int J Cancer. 2022 Feb 15;150(4):645-653. doi: 10.1002/ijc.33823. Epub 2021 Oct 5.
Treatment options for metastatic osteosarcomas are scarce. Following failure of standard first line therapy, patients who relapse present a challenging treatment dilemma, and have a poor prognosis. Surgical removal of all metastases is essential. A retrospective analysis of patients with metastatic osteosarcomas was conducted in 15 French Sarcoma Group centers. From January 2009 to December 2018, we identified 120 adult patients; 36 with synchronous and 84 with metachronous metastases with 74 males and 46 females. Mean age was 30 years (18-53). Metastatic sites were lung, bone and other in 91, 11 and 24 patients, respectively. Mean time to first metachronous metastases was 22 months (4-97). All patients except 13 (10.8%) with metachronous metastases received a first line systemic treatment for relapse, and 39 patients (32.5%) were included in a clinical trial. Eighty-one patients (67.5%) had local treatment of distant metastases. Median progression free survival (PFS) and overall survival (OS) were 5.5 (95% CI 4.6-6.4) and 20.5 months (95% CI 13.2-27.7) respectively for the overall group. In multivariate analysis, more than five metastases, time to first metastases <24 months, were statistically significant negative prognostic factors for OS and PFS (P = .002, ≤.001 and P = .006, ≤.001, respectively). Surgery of metastases was associated with better prognosis on OS and PFS (P = .001 and .037, respectively). The presence of bone metastases was a negative prognostic factor on OS but not on PFS (P = .021). In reference sarcoma centers, relapsed osteosarcoma patients with more than one metastasis commonly receive more than one line of systemic therapy, and are included in clinical trial if available.
转移性骨肉瘤的治疗选择有限。在标准一线治疗失败后，复发的患者面临着极具挑战性的治疗困境，预后较差。因此，必须彻底切除所有转移灶。我们对 15 个法国肉瘤研究组中心的转移性骨肉瘤患者进行了回顾性分析。2009 年 1 月至 2018 年 12 月，共纳入 120 例成人患者，其中 36 例为同步转移，84 例为异时性转移，男性 74 例，女性 46 例。平均年龄为 30 岁（18-53 岁）。转移部位为肺、骨和其他部位，分别为 91、11 和 24 例。首次异时性转移的中位时间为 22 个月（4-97 个月）。除 13 例（10.8%）异时性转移患者外，所有患者均接受了一线系统性治疗以缓解疾病复发，39 例（32.5%）患者入组临床试验。81 例（67.5%）患者对远处转移灶进行了局部治疗。总体患者的无进展生存期（PFS）和总生存期（OS）分别为 5.5 个月（95%CI：4.6-6.4）和 20.5 个月（95%CI：13.2-27.7）。多因素分析显示，转移灶数目多于 5 个、首次转移时间<24 个月是影响 OS 和 PFS 的显著负性预后因素（P=0.002、≤0.001 和 P=0.006、≤0.001）。转移灶手术与 OS 和 PFS 预后相关（P=0.001 和 P=0.037）。骨转移是 OS 的负性预后因素，但不是 PFS 的负性预后因素（P=0.021）。在参考肉瘤中心，复发的骨肉瘤患者通常有多个转移灶，接受了超过一线的系统性治疗，且如果有临床试验，通常会入组。
