Kask Gilber, Laitinen Minna K, Parry Michael C, Albergo Jose I, Stevenson Jonathan D, Farfalli German, Aponte-Tinao Luis, Grimer Robert, Sumathi Vaiyapuri, Jeys Lee M
Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, 00100 Helsinki, Finland.
Royal Orthopaedic Hospital, Birmingham and Aston University Medical School, Aston University, Birmingham B4 7ET, UK.
Cancers (Basel). 2023 Apr 17;15(8):2337. doi: 10.3390/cancers15082337.
Chondrosarcoma (CS) is the second most common primary malignant bone tumour and, in the absence of reliable chemotherapy and radiotherapy, is effectively a surgical disease. Overall disease specific survival (DSS) is affected by tumour grade, whilst resection margin contributes to local recurrence free survival (LRFS). The aim of this study was to investigate factors that affect the local and systemic prognoses for conventional central CSs arising from the proximal humerus. A multi-centre, retrospective study from three international collaborative sarcoma centres identified 110 patients between 1995 and 2020 undergoing treatment for a conventional central CS of the proximal humerus; 58 patients (53%) had a grade 1 tumour, 36 (33%) had a grade 2 tumour, and 16 patients (13%) had a grade 3 CS. The mean age of patients was 50 years (range 10-85). The incidence of local recurrence (LR) was 9/110 (8.2%), and the disease specific mortality was 6/110 (5.5%). The grade was a statistically significant factor for LRFS ( < 0.001). None of the grade 1 tumours developed LR. The DSS was affected by the grade ( < 0.001) but not by the LR ( = 0.4). Only one patient with a grade 2 tumour died from the disease. The proximal humeral grade 1 CS behaved as a benign tumour, having no cases of LR nor death due to disease. Grade 2 CSs of the proximal humerus behaved in a more indolent way when compared with comparable grade tumours elsewhere in the appendicular skeleton, being locally aggressive with a higher LR rate than grade 1 CSs but still having very low mortality and a high rate of DSS. The LR in grade 2 CSs did not affect the DSS; therefore, surgical management in proximal humeral grade 2 CSs should have a greater emphasis on preserving function whilst maintaining an adequate margin for resection. The proximal humeral grade 3 CS was, as elsewhere in the skeleton, an aggressive, high-grade tumour. Therefore, surgical management should include en bloc resection with clear margins to avoid LR.
软骨肉瘤（CS）是第二常见的原发性恶性骨肿瘤，在缺乏可靠的化疗和放疗的情况下，实际上是一种手术相关疾病。总体疾病特异性生存率（DSS）受肿瘤分级影响，而手术切缘则影响无局部复发生存率（LRFS）。本研究的目的是调查影响肱骨近端传统中央型CS局部和全身预后的因素。一项来自三个国际协作肉瘤中心的多中心回顾性研究确定了1995年至2020年间110例接受肱骨近端传统中央型CS治疗的患者；58例（53%）患者为1级肿瘤，36例（33%）为2级肿瘤，16例（13%）为3级CS。患者的平均年龄为50岁（范围10 - 85岁）。局部复发（LR）发生率为9/110（8.2%），疾病特异性死亡率为6/110（5.5%）。分级是LRFS的统计学显著因素（<0.001）。1级肿瘤均未发生LR。DSS受分级影响（<0.001），但不受LR影响（=0.4）。只有1例2级肿瘤患者死于该疾病。肱骨近端1级CS表现为良性肿瘤，无LR病例，也无疾病相关死亡。与四肢骨骼其他部位的同级肿瘤相比，肱骨近端2级CS的行为更为惰性，局部侵袭性高于1级CS，LR率更高，但死亡率仍然很低，DSS率很高。2级CS的LR不影响DSS；因此，肱骨近端2级CS的手术治疗应更强调在保持足够切除切缘的同时保留功能。肱骨近端3级CS与骨骼其他部位的情况一样，是一种侵袭性的高级别肿瘤。因此，手术治疗应包括进行切缘清晰的整块切除以避免LR。
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