Sever Nadiye, Şimşek Fatih, Onur İlknur Deliktaş, Arvas Hayati, Guliyev Tural, Şakalar Teoman, Çiçek Ceren Mordağ, Orman Seval, Çetin Emine Bihter, Kayaş Kamil, Akbaş Sinem, Ağyol Yeşim, Güren Ali Kaan, Erel Pınar, Kocaaslan Erkam, Paçacı Burak, Tunç Mustafa Alperen, Çelebi Abdussamet, Majidova Nargiz, Durnalı Ayşe, Şimşek Melih, Şahbazlar Mustafa, Işık Selver, Arıkan Rukiye, Ercelep Özlem, Sarı Murat, Köstek Osman, Bayoğu İbrahim Vedat
Division of Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul 34854, Turkey.
Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul 34854, Turkey.
J Clin Med. 2025 Mar 17;14(6):2024. doi: 10.3390/jcm14062024.
Osteosarcoma is a rare but aggressive bone malignancy. Despite advances in multimodal therapy, survival remains suboptimal, highlighting the need for prognostic markers to guide treatment. This study included 162 osteosarcoma patients who received neoadjuvant chemotherapy followed by surgery between January 2009 and March 2024. Patients received either double (cisplatin + doxorubicin) or triple (MAP or PEI) chemotherapy. Survival analyses were conducted using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. The median age was 20 years (IQR: 18-29), and 53.1% were male. Patients who received triple chemotherapy regimens demonstrated significantly longer overall survival (OS) compared to those on doublet regimens. High tumor necrosis rates (>90%) and negative surgical margins were strongly associated with improved OS, while metastatic disease at diagnosis, elevated alkaline phosphatase (ALP), and male gender were linked to poorer survival. Multivariate analysis identified adjuvant therapy, age under 18, high necrosis rate, negative margins, and normal ALP as significant OS predictors. Triple-agent chemotherapy, necrosis rate ≥90 and negative surgical margins are strongly associated with prolonged survival in osteosarcoma. The key prognostic indicators such as ALP levels, surgical margins and age at diagnosis should guide personalized treatment strategies to improve outcomes in curable patients.
骨肉瘤是一种罕见但侵袭性强的骨恶性肿瘤。尽管多模式治疗取得了进展，但生存率仍不理想，这凸显了需要预后标志物来指导治疗。本研究纳入了162例骨肉瘤患者，这些患者在2009年1月至2024年3月期间接受了新辅助化疗，随后接受了手术。患者接受了双药（顺铂+阿霉素）或三药（MAP或PEI）化疗。使用Kaplan-Meier曲线、对数秩检验和Cox比例风险模型进行生存分析。中位年龄为20岁（四分位间距：18-29岁），53.1%为男性。与接受双药方案的患者相比，接受三药化疗方案的患者总体生存期（OS）显著更长。高肿瘤坏死率（>90%）和手术切缘阴性与OS改善密切相关，而诊断时的转移性疾病、碱性磷酸酶（ALP）升高和男性性别与较差的生存率相关。多变量分析确定辅助治疗、18岁以下年龄、高坏死率、阴性切缘和正常ALP为显著的OS预测因素。三药联合化疗、坏死率≥90%和手术切缘阴性与骨肉瘤患者的生存期延长密切相关。关键的预后指标，如ALP水平、手术切缘和诊断时的年龄，应指导个性化治疗策略，以改善可治愈患者的治疗结果。
