四肢骨骼中央型高级别传统骨肉瘤疾病进展的预后因素：南非单中心经验及至少3年随访
Prognostic factors for disease progression of central high-grade conventional osteosarcoma of the appendicular skeleton: Single-centre experience within South Africa with minimum 3-year follow-up.
作者信息
Mthethwa PhakamaniG, Marais L C
机构信息
Head of Department of Orthopaedic Surgery, Consultant of Bone Tumours, Sepsis, and Limb Reconstruction, Dr Pixley Ka Isaka Seme Memorial Hospital, University of KwaZulu-Natal - Nelson Mandela School of Clinical Medicine, 310 Bhejane Street, KwaMashu, 4360, Durban, South Africa.
Head of School, Sepsis, and Limb Reconstruction, Nelson Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, 719 Umbilo Road, 4001, Durban, South Africa.
出版信息
J Orthop. 2024 Dec 25;65:126-131. doi: 10.1016/j.jor.2024.12.019. eCollection 2025 Jul.
BACKGROUND
Disease progression (DP) of osteosarcomas, albeit with aggressive treatments, hinders improving survival. The DP patterns are unique in low- and middle-income countries like South Africa. We determine the prognostic factors associated with disease progression (DP) of the appendicular skeleton's central high-grade conventional osteosarcoma (COS).
METHODS
This is a retrospective study of 77 patients, with a minimum 3-year follow-up period diagnosed with histological biopsy-confirmed COS. Descriptive statistics, Cox proportional regression modelling, and the Kaplan-Meier method were employed for the analysis.
RESULTS
DP occurred in 75 % of patients (58/77), either as a local progression - LP 32 % (25/77), systemic progression - SP 61 % (47/77) or both 32 % (24/77). In the univariate analysis, the factors associated with DP were proximal humerus tumor site (hazard ratio [HR] 2.48; 95 % confidence interval [CI], 1.02 to 6.04; p < 0.046), metastasis at diagnosis (HR 1.91; 95 % CI, 1.10 to 3.32; p < 0.022), multiple metastatic lesions (HR 2.58; 95 % CI, 1.13 to 5.88; p < 0.024), curative treatment (HR 0.33; 95 % CI 0.17 to 0.62; p < 0.001), palliative treatment (HR 2.17; 95 % CI 1.24 to 3.78; p < 0.007), and wide surgical resection (HR 0.48, 95 % CI 0.27 to 0.86; p < 0.013). On multivariate analysis, only age >19 years was an independent risk factor (HR 1.04; 95 % CI 1.00 to 1.08; p < 0.034). The median survival time was 24 months, with an overall survival (OS) of 57.1 % at 3 years. The projected Kaplan- Meier 5-year OS rate was 29.78 %, with a progression-free survival (PFS) rate of 10.28 % (HR 0.76; 95 % CI 0.52 to 1.112; p < 0.128).
CONCLUSION
In this series of central high-grade conventional osteosarcoma of the appendicular skeleton from South Africa, we observed a uniquely high proportion of disease progression (DP). Age >19, metastatic disease, and no chemotherapy response yielded poor outcomes; in contrast, wide surgical resection is beneficial. Further elucidation is needed at a larger scale in this region.
STUDY EVIDENCE LEVEL
IV.
背景
骨肉瘤的疾病进展（DP），尽管采用了积极的治疗方法，但仍阻碍了生存率的提高。在南非等低收入和中等收入国家，DP模式独具特色。我们确定与四肢骨骼中央高级别传统骨肉瘤（COS）疾病进展（DP）相关的预后因素。
方法
这是一项对77例患者的回顾性研究，这些患者经组织学活检确诊为COS，且随访期至少为3年。采用描述性统计、Cox比例回归模型和Kaplan-Meier方法进行分析。
结果
75%的患者（58/77）出现DP，表现为局部进展-LP 32%（25/77）、全身进展-SP 61%（47/77）或两者皆有32%（24/77）。在单因素分析中，与DP相关的因素包括肱骨近端肿瘤部位（风险比[HR] 2.48；95%置信区间[CI]，1.02至6.04；p < 0.046）、诊断时转移（HR 1.91；95% CI，1.10至3.32；p < 0.022）、多个转移病灶（HR 2.58；95% CI，1.13至5.88；p < 0.024）、根治性治疗（HR 0.33；95% CI 0.17至0.62；p < 0.001）、姑息性治疗（HR 2.17；95% CI 1.24至3.78；p < 0.007）以及广泛手术切除（HR 0.48，95% CI 0.27至0.86；p < 0.013）。在多因素分析中，只有年龄>19岁是独立危险因素（HR 1.04；95% CI 1.00至1.08；p < 0.034）。中位生存时间为24个月，3年总生存率（OS）为57.1%。预计的Kaplan-Meier 5年OS率为29.78%，无进展生存率（PFS）为10.28%（HR 0.76；95% CI 0.52至1.112；p < 0.128）。
结论
在这一系列来自南非的四肢骨骼中央高级别传统骨肉瘤中，我们观察到疾病进展（DP）的比例特别高。年龄>19岁、转移性疾病以及无化疗反应导致预后不良；相反，广泛手术切除有益。该地区需要更大规模的进一步阐明。
研究证据水平
IV级。
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