在中国天津，一家中心医院的 11 年经验：骨肉瘤肺转移患者的发病率、生存率及相关因素估计。
Incidence, survival, and associated factors estimation in osteosarcoma patients with lung metastasis: a single-center experience of 11 years in Tianjin, China.
机构信息
Department of Bone and Soft Tissue Tumors, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300000, China.
Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, China.
出版信息
BMC Cancer. 2023 Jun 5;23(1):506. doi: 10.1186/s12885-023-11024-9.
BACKGROUND
Osteosarcoma is the most common primary malignant bone tumor. The current study was conducted to describe the general condition of patients with primary osteosarcoma in a single cancer center in Tianjin, China and to investigate the associated factors in osteosarcoma patients with lung metastasis.
METHODS
From February 2009 to October 2020, patients from Tianjin Medical University Cancer Institute and Hospital, China were retrospectively analyzed. The Kaplan-Meier method was used to evaluate the overall survival of osteosarcoma patients. The Cox proportional hazard regression analysis was performed to analyze the prognostic factors of all osteosarcoma patients and those patients with lung metastasis, respectively. Furthermore, risk factors for developing lung metastasis were identified in synchronous lung metastasis (SLM) and metachronous lung metastasis (MLM) patients.
RESULTS
A total of 203 patients were involved and 150 patients were successfully followed up for survival status. The 5-year survival rate of osteosarcoma was 70.0% and the survival months for patients with SLM and MLM were 33.3 ± 12.6 and 45.8 ± 7.4 months, respectively. The presence of lung metastasis was one of the independent prognostic factors for prognosis of osteosarcoma. In patients with lung metastasis, twenty-one (10.3%) showed lung metastasis at the diagnosis of osteosarcoma and 67 (33%) were diagnosed with lung metastases during the later course. T3 stage (OR = 11.415, 95%CI 1.362-95.677, P = 0.025) and bone metastasis (OR = 6.437, 95%CI 1.69-24.51, P = 0.006) were risk factors of SLM occurrence. Bone metastasis (OR = 1.842, 95%CI 1.053-3.224, P = 0.032), good necrosis (≥ 90%, OR = 0.032, 95%CI 0.050-0.412, P < 0.001), elevated Ki-67 (OR = 2.958, 95%CI 1.098-7.969, P = 0.032) and elevated LDH (OR = 1.791, 95%CI 1.020-3.146, P = 0.043) were proved to be independent risk factors for developing MLM.
CONCLUSION
The overall survival, prognostic factors and risk factors for lung metastasis in this single center provided insight about osteosarcoma management.
背景
骨肉瘤是最常见的原发性恶性骨肿瘤。本研究旨在描述中国天津某单一癌症中心原发性骨肉瘤患者的一般情况，并探讨骨肉瘤患者发生肺转移的相关因素。
方法
回顾性分析 2009 年 2 月至 2020 年 10 月于天津医科大学肿瘤医院就诊的患者。采用 Kaplan-Meier 法评估骨肉瘤患者的总生存率。采用 Cox 比例风险回归分析分别分析所有骨肉瘤患者和肺转移患者的预后因素。此外，还确定了同步肺转移（SLM）和异时性肺转移（MLM）患者发生肺转移的危险因素。
结果
共纳入 203 例患者，其中 150 例成功随访生存状态。骨肉瘤患者的 5 年生存率为 70.0%，SLM 和 MLM 患者的生存月份分别为 33.3±12.6 和 45.8±7.4 个月。肺转移是骨肉瘤预后的独立预后因素之一。在发生肺转移的患者中，21 例（10.3%）在诊断为骨肉瘤时即发生肺转移，67 例（33%）在病程后期诊断为肺转移。T3 期（OR=11.415，95%CI 1.362-95.677，P=0.025）和骨转移（OR=6.437，95%CI 1.69-24.51，P=0.006）是 SLM 发生的危险因素。骨转移（OR=1.842，95%CI 1.053-3.224，P=0.032）、良好的肿瘤坏死（≥90%，OR=0.032，95%CI 0.050-0.412，P<0.001）、Ki-67 升高（OR=2.958，95%CI 1.098-7.969，P=0.032）和乳酸脱氢酶（LDH）升高（OR=1.791，95%CI 1.020-3.146，P=0.043）被证明是发生 MLM 的独立危险因素。
结论
本中心的骨肉瘤患者的总生存率、预后因素和肺转移风险因素为骨肉瘤的治疗提供了新的见解。
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