Yang R S, Eckardt J J, Eilber F R, Rosen G, Forscher C A, Dorey F J, Kelly C M, al-Shaikh R
Department of Orthopaedic Surgery, UCLA School of Medicine 90095-6902, USA.
Cancer. 1995 Oct 15;76(8):1388-97. doi: 10.1002/1097-0142(19951015)76:8<1388::aid-cncr2820760814>3.0.co;2-f.
Despite advances in adjuvant therapy, Ewing's sarcoma of the pelvis remains an anatomic site with a poor prognosis. This study evaluate the role of surgery in the management of patients with pelvic Ewing's sarcoma who also received conventional radiation therapy and chemotherapy.
From May 1978 to February 1994, 19 patients with Stage IIB Ewing's sarcoma of the pelvis were treated at the UCLA Medical Center (Los Angeles, CA). There were eight lesions of the ilium, two of the sacrum, and nine involving two adjoining regions of pelvis. All patients received conventional medical management. The 19 patients were divided into two groups according to treatment modality. A group of 12 patients (Group A) had surgical resection, and their results were compared with those of another group of 7 patients (Group B) who did not have surgery.
The 5-year cumulative survival (Kaplan-Meier method) was 39% for all patients, 51% for Group A, and 18% for Group B. The 3-year cumulative survival was 59% for all patients, 72% for Group A, and 36% for Group B. Although the survival rate of Group A seemed better than that of Group B, the difference was not statistically significant (P = 0.093, log rank method). This study also suggested that, regardless of treatment modality, the outcome of patients with lesions involving two adjoining pelvic bones was poorer than that of those with a single lesion. In Group A, the 3-year cumulative survival rate for patients with single bone lesions (n = 8) was 86% and for patients with lesions involving two adjoining pelvic bones (n = 4) was 50% (P = 0.045, log rank method). Furthermore, the statistical analysis of the combined data of the single pelvic bone lesions in UCLA and that of Mayo Clinic series (n = 16 for surgery group and n = 15 for nonsurgery group) confirmed the better results for the surgical patients, which was consistent with the results from the Mayo Clinic with an even greater significance (P < 0.002).
This study demonstrates that surgery plus chemotherapy and radiation therapy is helpful for treating patients with pelvic Ewing's sarcoma so long as the tumor is limited to a single pelvic bone.
尽管辅助治疗取得了进展，但骨盆尤文肉瘤的预后仍然很差。本研究评估了手术在接受传统放疗和化疗的骨盆尤文肉瘤患者治疗中的作用。
1978年5月至1994年2月，加州大学洛杉矶分校医疗中心（加利福尼亚州洛杉矶）治疗了19例IIB期骨盆尤文肉瘤患者。其中8例为髂骨病变，2例为骶骨病变，9例累及骨盆的两个相邻区域。所有患者均接受了传统的药物治疗。根据治疗方式将19例患者分为两组。一组12例患者（A组）接受了手术切除，并将其结果与另一组7例未接受手术的患者（B组）进行比较。
所有患者的5年累积生存率（Kaplan-Meier法）为39%，A组为51%，B组为18%。3年累积生存率：所有患者为59%，A组为72%，B组为36%。虽然A组的生存率似乎优于B组，但差异无统计学意义（P = 0.093，对数秩检验法）。本研究还表明，无论治疗方式如何，累及骨盆两块相邻骨头的病变患者的预后比单一病变患者的预后差。在A组中，单骨病变患者（n = 8）的3年累积生存率为86%，累及骨盆两块相邻骨头的病变患者（n = 4）的3年累积生存率为50%（P = 0.045，对数秩检验法）。此外，对加州大学洛杉矶分校单骨盆骨病变数据与梅奥诊所系列数据（手术组n = 16，非手术组n = 15）的合并数据进行统计分析，证实了手术患者的结果更好，这与梅奥诊所的结果一致，且具有更大的显著性（P < 0.002）。
本研究表明，只要肿瘤局限于单个骨盆骨，手术联合化疗和放疗有助于治疗骨盆尤文肉瘤患者。
