Taylor W F, Ivins J C, Pritchard D J, Dahlin D C, Gilchrist G S, Edmonson J H
Mayo Clin Proc. 1985 Feb;60(2):91-104. doi: 10.1016/s0025-6196(12)60293-6.
This report is an update of a 1978 article on osteosarcoma in Mayo Clinic patients. It includes additional follow-up on previously reported cases and incorporates new cases treated since the time of that original study. From 1963 through 1981, 336 patients with classic, previously untreated osteosarcoma received their first definitive treatment at our institution. Survival of these patients was studied in detail. The most significant result was that survival in the 1960s was much worse than that in the 1970s. The first evidence of improvement in survival was noted in 1969; subsequently, further improvement occurred but was not consistent. This finding prevailed with respect to duration of survival to death, survival to detection of metastasis, and survival from occurrence of metastasis to death. On the basis of detailed regression analysis, several variables had independent prognostic value. From these findings, a prognostic score was developed, which was based on the number of the following unfavorable characteristics: age younger than 10 years, male sex, tumor diameter more than 15 cm, cell type osteoblastic or chondroblastic, duration of symptoms 2 months or less, and involvement of the femur or humerus. Patients with five or six of these unfavorable characteristics had a very poor survival; in contrast, patients with only one or two characteristics had a good outcome. Even when these scores were fairly constant, however, the calendar period had a strong influence on survival. Likewise, when treatment was considered and adjustments by score were made, no significant differences could be found between those patients treated by amputation only and those treated by amputation supplemented with chemotherapy or radiotherapy.
本报告是对1978年发表的一篇关于梅奥诊所骨肉瘤患者的文章的更新。它包括对先前报告病例的额外随访，并纳入了自原始研究以来治疗的新病例。1963年至1981年期间，336例经典的、未经治疗的骨肉瘤患者在我们机构接受了首次确定性治疗。对这些患者的生存情况进行了详细研究。最显著的结果是，20世纪60年代的生存率远低于70年代。1969年首次注意到生存率有所改善；随后，虽有进一步改善，但并不稳定。这一发现适用于从存活到死亡的持续时间、到转移检测的存活情况以及从转移发生到死亡的存活情况。基于详细的回归分析，几个变量具有独立的预后价值。根据这些发现，制定了一个预后评分，该评分基于以下不利特征的数量：年龄小于10岁、男性、肿瘤直径超过15厘米、细胞类型为成骨细胞型或软骨母细胞型、症状持续时间2个月或更短以及股骨或肱骨受累。具有五个或六个这些不利特征的患者生存率非常低；相比之下，只有一个或两个特征的患者预后良好。然而，即使这些评分相当稳定，日历时间对生存率仍有很大影响。同样，当考虑治疗并按评分进行调整时，仅接受截肢治疗的患者与接受截肢并辅以化疗或放疗的患者之间未发现显著差异。
