Idoate Miguel Á, Aquerreta Jesús Dámaso, Lamo-Espinosa José María, San-Julian Mikel
Department of Pathology, Clínica Universidad de Navarra, University of Navarra, 31008 Pamplona, Spain.
Department of Radiology, Clínica Universidad de Navarra, University of Navarra, 31008 Pamplona, Spain.
Diagnostics (Basel). 2022 Feb 9;12(2):450. doi: 10.3390/diagnostics12020450.
Osteosarcoma is a primary malignant bone tumor usually arising at the metaphysis of long bones, particularly around the knee. The physis has been regarded as a barrier capable of blocking tumor extension, thus allowing it to preserve their epiphysis and therefore improve functional results. With the objective of clarifying how effective the physis is as a barrier to tumor spread, a large series of skeletally immature patients with osteosarcoma were reviewed. From 452 metaphyseal osteosarcomas a selection of 282 cases in which the tumor was close or crossing the physis were carried out. This sub-sample was split into two groups according to the surgical treatment (epiphyseal preservation or not). The specimens obtained by resection were studied, and the physeal and metaphyseal areas were studied by multiple sections. Immunostaining against VEGF of physis was obtained in selected cases. In about half of the patients affected by metaphyseal malignant bone tumors, the growth plate and epiphysis were not compromised by the tumor. Three sequential invasive growth patterns of an osteosarcoma in its relationship with the physis could be distinguished. An intense angiogenesis and osteoclastic reaction could be observed in the growth plate in the free zone between the tumor and the physis. The local recurrence incidence was lower in the epiphyseal preservation treated patients than it was in the conventional treatment (8% vs. 12%). Most local recurrences appeared in the first 2 years. The overall survival of patients treated with epiphyseal preservation was better than that of the patients treated without preserving the epiphysis (73% vs. 59%; = 0.03) at a mean follow-up of 18 years. We have described an angiogenic and osteoclastic reaction in the base of the growth plate in the proximity of the advance front of the tumor, which could facilitate the osteosarcoma invasion. It is also shown that the preoperative imaging method for examination is a valid approach for the decision to carry out epiphyseal preservation. Finally, we concluded that epiphyseal preservation combined with protective chemotherapy is an excellent clinical approach for selected patients with metaphyseal osteosarcoma.
骨肉瘤是一种原发性恶性骨肿瘤，通常发生于长骨的干骺端，尤其是膝关节周围。生长板被认为是一种能够阻挡肿瘤扩散的屏障，从而使其能够保留骨骺，进而改善功能结果。为了阐明生长板作为肿瘤扩散屏障的有效性，我们回顾了一系列大量骨骼未成熟的骨肉瘤患者。从452例干骺端骨肉瘤中选取了282例肿瘤接近或穿过生长板的病例。根据手术治疗方式（是否保留骨骺）将该亚样本分为两组。对切除获得的标本进行研究，并通过多个切片对生长板和干骺端区域进行研究。在部分选定病例中对生长板进行了VEGF免疫染色。在大约一半的干骺端恶性骨肿瘤患者中，生长板和骨骺未受肿瘤侵犯。可以区分骨肉瘤与生长板关系的三种连续侵袭生长模式。在肿瘤与生长板之间的自由区域的生长板中可观察到强烈的血管生成和破骨细胞反应。保留骨骺治疗的患者局部复发率低于传统治疗患者（8%对12%）。大多数局部复发发生在头2年。在平均18年的随访中，保留骨骺治疗患者的总生存率优于未保留骨骺的患者（73%对59%；P = 0.03）。我们描述了在肿瘤前沿附近生长板底部的血管生成和破骨细胞反应，这可能促进骨肉瘤的侵袭。还表明术前影像学检查方法是决定是否进行骨骺保留的有效方法。最后，我们得出结论，保留骨骺联合保护性化疗是选定的干骺端骨肉瘤患者的一种优秀临床方法。
