骨放射性诱导肉瘤：基于组织学和手术治疗的结果：文献系统回顾。

Bone Radiation-Induced Sarcomas: Outcomes Based on Histology and Surgical Treatment: A Systematic Review of the Literature.

机构信息

Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.

Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

出版信息

JBJS Rev. 2024 Aug 5;12(8). doi: e24.00066. eCollection 2024 Aug 1.

DOI:10.2106/JBJS.RVW.24.00066

PMID:39102470

Abstract

BACKGROUND

Bone radiation-induced sarcomas (B-RIS) are secondary neoplasms with reportedly worse overall survival than de novo bone sarcoma. Treatment strategy for these neoplasms remains uncertain. Our systematic review sought to assess overall survival based on histology and surgical intervention.

METHODS

A systemic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO (438415). Studies describing oncologic outcomes of patients with B-RIS in the appendicular and axial skeleton were included. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Survival analysis by histologic subtype and surgery type was performed in a subset of 234 patients from 11 articles with individualized data. A total of 20 articles with a total of 566 patients were included. The most frequent location was the pelvis (27.7%), and the main histological types were osteosarcoma (69.4%), undifferentiated pleomorphic sarcoma (14.1%), and fibrosarcoma (9.2%). Limb-salvage and amputation were performed in 68.5% and 31.5% of cases, respectively.

RESULTS

Local recurrence was 13%, without difference between limb-salvage surgery and amputation (p = 0.51). The metastasis rate was 42.3%. Five-year OS was 43.7% (95% confidence interval [CI], 33.3%-53.5%) for osteosarcoma, 31.5% (95% CI, 11.3%-54.2%) for UPS, and 28.1% (95% CI, 10.6%-48.8%) for fibrosarcoma. Five-year OS was 49.2% (95% CI, 35.3%-61.6%) for limb-salvage and 46.9% (95% CI, 29.1%-62.9%) for amputation. There was no difference in 5-year OS between histologic subtypes (p = 0.18) or treatment type (p = 0.86).

CONCLUSION

B-RIS demonstrated poor OS at 5 years after initial management regardless of histology. Limb-salvage surgery was not associated with lower 5-year OS compared with amputation. Future studies should compare both groups while controlling for confounders.

LEVEL OF EVIDENCE

Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

骨放射性诱导肉瘤（B-RIS）是一种继发性肿瘤，其总生存率比初发性骨肉瘤差。这些肿瘤的治疗策略仍不确定。我们的系统评价旨在根据组织学和手术干预评估总生存率。

方法

按照系统评价和荟萃分析的首选报告项目（Preferred Reporting Items for Systematic reviews and Meta-Analyses，PRISMA）指南进行系统评价，并在 PROSPERO（438415）中进行注册。纳入描述四肢和脊柱骨骼中 B-RIS 患者的肿瘤学结局的研究。使用观察性研究的强化报告标准（Strengthening the Reporting of Observational Studies in Epidemiology，STROBE）检查表进行质量评估。对来自 11 篇文章的 234 名患者的个体化数据进行组织学亚型和手术类型的生存分析。共纳入 20 篇文章，共 566 例患者。最常见的部位是骨盆（27.7%），主要的组织学类型为骨肉瘤（69.4%）、未分化多形性肉瘤（14.1%）和纤维肉瘤（9.2%）。保肢手术和截肢分别在 68.5%和 31.5%的病例中进行。

结果

局部复发率为 13%，保肢手术与截肢之间无差异（p=0.51）。转移率为 42.3%。骨肉瘤的 5 年 OS 为 43.7%（95%可信区间[CI]，33.3%-53.5%），UPS 为 31.5%（95% CI，11.3%-54.2%），纤维肉瘤为 28.1%（95% CI，10.6%-48.8%）。保肢的 5 年 OS 为 49.2%（95% CI，35.3%-61.6%），截肢为 46.9%（95% CI，29.1%-62.9%）。组织学亚型（p=0.18）或治疗类型（p=0.86）之间 5 年 OS 无差异。