Ward W G, Mikaelian K, Dorey F, Mirra J M, Sassoon A, Holmes E C, Eilber F R, Eckardt J J
Department of Orthopaedic Surgery, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157-1070.
J Clin Oncol. 1994 Sep;12(9):1849-58. doi: 10.1200/JCO.1994.12.9.1849.
This study investigated prognostic factors in nonmetastatic high-grade extremity osteosarcoma and the prognosis following resection of subsequent pulmonary metastases, with emphasis on the effect of chemotherapy-induced tumor necrosis.
We reviewed 111 consecutive patients with high-grade nonmetastatic extremity osteosarcoma treated with preoperative chemotherapy and surgical resection, with additional review of 36 patients who had subsequent pulmonary metastases resected.
The overall 5-year survival rate was 53%. In resected primary tumors, tumor-free resection margin (P < .001) and increasing chemotherapy-induced tumor necrosis (> 90% threshold, P < .003) correlated with increased metastasis-free survival. Relative risk factors for metastases were as follows: tumor-containing resection margin (most likely to metastasize); poor response to preoperative chemotherapy and/or lack of postoperative chemotherapy (next worse prognosis); and excellent response to preoperative chemotherapy (> or = 90% necrosis) combined with postoperative chemotherapy (best prognosis). The 5-year survival rate following pulmonary metastasis resection was 23%, whereas a 0% 4-year survival rate followed development of bony metastases (P < .001). The extent of tumor necrosis in resected pulmonary metastases did not affect prognosis. Survival was best in patients with three or fewer pulmonary nodules (P < .048), four or fewer recurrent pulmonary nodules (P < .047), unilateral pulmonary metastases (P < .037), or longer intervals between primary tumor resection and metastases (P < .082).
Intensive preoperative and postoperative chemotherapy combined with complete resection of both primary and metastatic pulmonary osteosarcomas is justified, with a goal of 100% tumor necrosis and excision. Although current treatment regimens allow effective salvage therapy for a few patients with pulmonary metastases, more effective systemic treatment is needed.
本研究调查了非转移性高级别肢体骨肉瘤的预后因素以及后续肺转移瘤切除术后的预后情况，重点关注化疗诱导的肿瘤坏死的影响。
我们回顾了111例接受术前化疗和手术切除的连续性高级别非转移性肢体骨肉瘤患者，并额外回顾了36例接受后续肺转移瘤切除术的患者。
总体5年生存率为53%。在切除的原发性肿瘤中，无瘤切除边缘（P <.001）和化疗诱导的肿瘤坏死增加（> 90%阈值，P <.003）与无转移生存期延长相关。转移的相对危险因素如下：含肿瘤切除边缘（最易转移）；对术前化疗反应不佳和/或缺乏术后化疗（预后次差）；对术前化疗反应良好（坏死率≥90%）并结合术后化疗（预后最佳）。肺转移瘤切除术后的5年生存率为23%，而骨转移发生后的4年生存率为0%（P <.001）。切除的肺转移瘤中的肿瘤坏死程度不影响预后。肺结节三个或更少（P <.048）、复发性肺结节四个或更少（P <.047）、单侧肺转移（P <.037）或原发性肿瘤切除与转移之间间隔时间更长（P <.082）的患者生存率最佳。
术前和术后强化化疗联合原发性和转移性肺骨肉瘤的完全切除是合理的，目标是实现100%肿瘤坏死和切除。尽管目前的治疗方案允许对少数肺转移患者进行有效的挽救治疗，但仍需要更有效的全身治疗。
