Derstappen T, Roessner A, Müller K M, Grundmann E
J Cancer Res Clin Oncol. 1987;113(3):241-8. doi: 10.1007/BF00396380.
Osteosarcoma is known to metastasize rather early, and even after surgical resection of the primary metastases may occur predominantly in the lung. Administration of polychemotherapy for destruction of micrometastases has served to improve prognosis. Preoperative chemotherapy facilitates the evaluation of regression, another factor of high prognostic relevance. Morphologic analysis of pulmonary metastases developing during chemotherapy is of considerable interest on account of the potential therapy resistance of certain histologic subtypes of osteosarcoma. In the present study pulmonary metastases resected in 20 thoracotomies of 15 osteosarcoma patients were investigated by light microscopy and compared, if possible, to the respective primaries. All patients had received chemotherapy, predominantly according to the COSS 80 and COSS 82 protocols. The histologic picture of a tumor was found to change from the primary to the pulmonary metastasis, a pattern also verified in the lung metastases collected in consecutive thoracotomies from the same patient. Several different subtypes were regularly found side by side in the metastases, but generally no special sensitivity or resistance to chemotherapy could be attributed to any of these subtypes. Our results nevertheless do indicate an increased resistance of anaplastic tumor tissue. The response to chemotherapy agreed in 9 of 10 primaries with that of their metastases.
骨肉瘤已知转移较早，甚至在原发灶手术切除后，转移仍可能主要发生在肺部。采用多药化疗破坏微转移灶有助于改善预后。术前化疗便于评估肿瘤退缩情况，这是另一个具有高度预后相关性的因素。鉴于骨肉瘤某些组织学亚型可能存在治疗抵抗性，对化疗期间发生的肺转移进行形态学分析具有重要意义。在本研究中，对15例骨肉瘤患者行20次开胸手术切除的肺转移灶进行了光学显微镜检查，并尽可能与相应的原发灶进行比较。所有患者均接受了化疗，主要依据COSS 80和COSS 82方案。发现肿瘤的组织学表现从原发灶到肺转移灶会发生变化，同一患者连续开胸手术收集的肺转移灶中也证实了这一模式。在转移灶中经常能同时发现几种不同的亚型，但一般而言，无法将任何一种亚型的特殊敏感性或耐药性归因于这些亚型。然而，我们的结果确实表明间变性肿瘤组织的耐药性增加。10例原发灶中有9例对化疗的反应与其转移灶一致。
