Bieling P, Rehan N, Winkler P, Helmke K, Maas R, Fuchs N, Bielack S, Heise U, Jurgens H, Treuner J, Romanowski R, Exner U, Kotz R, Winkler K
Department of Pediatric Oncology, University of Hamburg, Germany.
J Clin Oncol. 1996 Mar;14(3):848-58. doi: 10.1200/JCO.1996.14.3.848.
The aim of this retrospective analysis was to investigate the prognostic significance and optimal measures of tumor size in osteosarcoma treated with intensive neoadjuvant chemotherapy.
Initial anterior-posterior (AP) and lateral x-ray films of 128 patients treated within the trials Cooperative Osteosarcoma Study (COSS)-80, -82, and -86, were evaluated for the following three tumor diameters: length, width, and depth. Metastasis-free survival (MFS) analyses were performed in univariate and multivariate models with one, two, and three dimensions of the tumor as absolute or relative measures (tumor length, referred to bone length, plane and volume to body-surface area).
Univariate analyses of MFS showed a high prognostic significance of all absolute measures. Relative measures, at best, showed a comparable predictive value. Cox regression analysis indicated the high prognostic significance of absolute tumor volume (ATV; P < .0001) and histologic response (P < .0001). None of 19 patients with an ATV < or = 70 cm3 and only four of 53 with an ATV < or = 150 cm3 relapsed, while in patients with an ATV more than 150 cm3, the relapse rate remained 40% to 60%, irrespective of further increase in volume.
Initial tumor size is an important and easily obtainable prognostic factor in osteosarcoma and may serve as a basis for risk-adapted therapy. It is best represented by the absolute three-dimensional measure ATV. There is a cut-off point regarding the incidence of metastases at a tumor volume of approximately 150 cm3 as calculated from two-plane x-ray films.
本回顾性分析旨在研究骨肉瘤患者接受强化新辅助化疗时肿瘤大小的预后意义及最佳测量方法。
对在骨肉瘤协作研究（COSS）-80、-82和-86试验中接受治疗的128例患者的初始前后位（AP）和侧位X线片进行评估，测量以下三个肿瘤直径：长度、宽度和深度。在单变量和多变量模型中进行无转移生存期（MFS）分析，将肿瘤的一维、二维和三维作为绝对或相对测量指标（肿瘤长度相对于骨长度、平面和体积相对于体表面积）。
MFS的单变量分析显示所有绝对测量指标均具有较高的预后意义。相对测量指标充其量显示出相当的预测价值。Cox回归分析表明绝对肿瘤体积（ATV；P <.0001）和组织学反应（P <.0001）具有较高的预后意义。19例ATV≤70 cm³的患者均未复发，53例ATV≤150 cm³的患者中只有4例复发，而ATV超过150 cm³的患者，无论体积进一步增加，复发率仍为40%至60%。
初始肿瘤大小是骨肉瘤中一个重要且易于获得的预后因素，可作为风险适应性治疗的基础。它最好由绝对三维测量指标ATV来表示。根据双平面X线片计算，肿瘤体积约150 cm³时转移发生率存在一个临界点。
