四肢和躯干高级别骨肉瘤的预后因素：新辅助化疗协作组骨肉瘤研究方案 1702 例患者的分析。

Prognostic Factors in High-Grade Osteosarcoma of theExtremities or Trunk: An Analysis of 1,702 Patients Treatedon Neoadjuvant Cooperative Osteosarcoma Study GroupProtocols.

机构信息

From the Klinik und Poliklinik für Kinderheilkunde, Pädiatrische Hämatologie/Onkologie, and Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinikum, Münster; Abteilung für Osteopathologie, Abteilung fur Pädiatrische Radiologie, and Abteilung für Pädiatrische Hämatologie und Onkologie, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany; Universitätsklinik für Orthopädie, Wiener Knochengeschwulstregister, and St Anna Kinderspital, Vienna, Austria; and Orthopädische Universitätsklinik Balgrist, Zurich, Switzerland.

出版信息

J Clin Oncol. 2023 Sep 20;41(27):4323-4337. doi: 10.1200/JCO.22.02767.

DOI:10.1200/JCO.22.02767

PMID:37713812

Abstract

PURPOSE

To define prognostic factors for response and long-term outcome for a wide spectrum of osteosarcomas, extending well beyond those of the typical young patient with seemingly localized extremity disease.

PATIENTS AND METHODS

A total of 1,702 consecutive newly diagnosed patients with high-grade osteosarcoma of the trunk or limbs registered into the neoadjuvant studies of the Cooperative Osteosarcoma Study Group before July 1998 were entered into an analysis of demographic, tumor-related, and treatment-related variables, response, and survival. The intended therapeutic strategy included preoperative and postoperative chemotherapy with multiple agents as well as surgery of all operable lesions.

RESULTS

Axial tumor site, male sex, and a long history of symptoms were associated with poor response to chemotherapy in univariate and multivariate analysis. Actuarial 10-year overall and event-free survival rates were 59.8% and 48.9%. Among the variables assessable at diagnosis, patient age (actuarial 10-year survival ≥ 40, 41.6%; < 40, 60.2%; = .012), tumor site (axial, 29.2%; limb, 61.7%; < .0001), and primary metastases (yes, 26.7%; no, 64.4%; < .0001), and for extremity osteosarcomas, also size (≥ one third, 52.5%; < one third, 66.7%; < .0001) and location within the limb (proximal, 49.3%; other, 63.9%; < .0001), had significant influence on outcome. Two additional important prognostic factors were treatment related: response to chemotherapy (poor, 47.2%; good, 73.4%; < .0001) and the extent of surgery (incomplete, 14.6%; macroscopically complete, 64.8%; < .0001). All factors except age maintained their significance in multivariate testing, with surgical remission and histologic response emerging as the key prognostic factors.

CONCLUSION

Tumor site and size, primary metastases, response to chemotherapy, and surgical remission are of independent prognostic value in osteosarcoma.

摘要

目的

定义广泛的骨肉瘤（包括肢体和躯干）对反应和长期结果的预后因素，这些因素超出了典型的局限性年轻患者的范围。

方法

1998 年 7 月之前，在新辅助研究中，共纳入 1702 例连续确诊的高级别肢体和躯干骨肉瘤患者，对其进行分析，分析内容包括人口统计学、肿瘤相关和治疗相关变量、反应和生存。旨在治疗策略包括术前和术后联合使用多种药物化疗以及对所有可手术病变进行手术。

结果

肿瘤轴向部位、男性和较长的症状史与单变量和多变量分析中化疗反应不良相关。10 年总生存率和无事件生存率分别为 59.8%和 48.9%。在可评估的诊断变量中，患者年龄（10 年生存率≥40 岁，41.6%；＜40 岁，60.2%；＝0.012）、肿瘤部位（轴向，29.2%；肢体，61.7%；＜0.0001）、以及首发转移（有，26.7%；无，64.4%；＜0.0001），以及对于肢体骨肉瘤，肿瘤大小（≥1/3，52.5%；＜1/3，66.7%；＜0.0001）和肿瘤在肢体中的位置（近端，49.3%；其他部位，63.9%；＜0.0001）也显著影响预后。另外两个重要的预后因素与治疗相关：化疗反应（差，47.2%；好，73.4%；＜0.0001）和手术范围（不完全，14.6%；宏观完全，64.8%；＜0.0001）。除年龄外，所有因素在多变量检验中均保持其意义，手术缓解和组织学反应成为关键的预后因素。