Picci P, Sangiorgi L, Rougraff B T, Neff J R, Casadei R, Campanacci M
Laboratory for Oncology Research, Rizzoli Institute, Bologna, Italy.
J Clin Oncol. 1994 Dec;12(12):2699-705. doi: 10.1200/JCO.1994.12.12.2699.
To assess patients with high-grade osteosarcoma treated at our institution for various prognostic factors for the development of local recurrence of disease. Follow-up data were available for all patients and the mean follow-up duration was 65 months in surviving patients.
There were 28 local recurrences in this study (7%). Of these, only three patients (11%) were alive at the most recent follow-up point, 28, 53, and 54 months after local recurrence. None of 59 patients who were treated primarily with a radical amputation and none of 10 who underwent a rotationplasty developed local recurrence. Four of 48 patients (8%) who had wide amputations, one of whom had an intralesional amputation, and 23 of 237 (10%) who had limb-salvage surgery developed locally recurrent disease. Of 237 patients who underwent limb-sparing resection, three prognostic factors for local control were identified. The strongest association with local recurrence was chemotherapy response (P < .0001), followed closely by surgical margins (P = .0001). Older patients were more likely to have locally recurrent disease (P = .033), with each decade of life older than the first decade having a relative risk of 1.5 times greater per decade (SE = 0.16; 95% confidence interval, 0.034 to .0650). Factors that were not associated with local recurrence included sex, date of diagnosis, and anatomic site of disease.
Chemotherapy-induced tumor necrosis and surgical margins are important prognostic factors for local control of patients with osteosarcoma.
评估在我院接受治疗的高级别骨肉瘤患者发生疾病局部复发的各种预后因素。所有患者均有随访数据，存活患者的平均随访时间为65个月。
本研究中有28例局部复发（7%）。其中，在局部复发后最近一次随访时，即28、53和54个月时，只有3例患者（11%）存活。59例主要接受根治性截肢治疗的患者和10例接受旋转成形术的患者均未发生局部复发。48例行广泛截肢的患者中有4例（8%）发生局部复发性疾病，其中1例为病损内截肢，237例行保肢手术的患者中有23例（10%）发生局部复发性疾病。在237例行保肢切除的患者中，确定了3个局部控制的预后因素。与局部复发关联最强的是化疗反应（P < .0001），其次是手术切缘（P = .0001）。老年患者更易发生局部复发性疾病（P = .033），每增加一个十年，相对于第一个十年，局部复发性疾病的相对风险每十年增加1.5倍（标准误 = 0.16；95%置信区间，0.034至0.0650）。与局部复发无关的因素包括性别、诊断日期和疾病的解剖部位。
化疗诱导的肿瘤坏死和手术切缘是骨肉瘤患者局部控制的重要预后因素。
