August M, Magennis P, Dewitt D
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston 02114, USA.
Int J Oral Maxillofac Surg. 1997 Jun;26(3):198-204. doi: 10.1016/s0901-5027(97)80819-3.
Thirty cases of osteosarcoma of the jaws were reviewed (20 men and 10 women, mean age 34 years). Seventeen lesions occurred in the mandible and 13 in the maxilla. Swelling without pain was the most common presenting symptom. Thirteen lesions were initially misdiagnosed as odontogenic infections. Numbness as a presenting symptom was statistically associated with poor prognosis. Treatment included all combinations of surgery, chemotherapy and radiotherapy. Patients receiving chemotherapy with four or more agents showed a trend toward better survival with 71% alive and disease-free at the time of review. Patients' increasing age was statistically associated with decreased survival. The average age of survivors was 27 years and nonsurvivors, 40 years. Older patients suffered more local recurrences which, in all but one case, resulted in mortality. Expectedly, clear surgical margins correlated statistically with improved survival. With margins of less than 5 mm, 27% of patients were alive and disease-free as compared to 62% with surgical margins greater than 5 mm. The importance of early diagnosis, definitive surgical treatment and aggressive adjuvant chemotherapy is demonstrated. The Proportional Hazards Regression model was employed to evaluate the statistical significance of a variety of factors on disease-free and overall survival.
回顾了30例颌骨骨肉瘤病例（20例男性，10例女性，平均年龄34岁）。17例病变发生在下颌骨，13例发生在上颌骨。最常见的首发症状是无痛性肿胀。13例病变最初被误诊为牙源性感染。首发症状为麻木在统计学上与预后不良相关。治疗包括手术、化疗和放疗的所有组合。接受四种或更多药物化疗的患者显示出更好的生存趋势，在复查时71%存活且无疾病。患者年龄增长在统计学上与生存率降低相关。存活者的平均年龄为27岁，非存活者为40岁。老年患者局部复发更多，除1例病例外，均导致死亡。不出所料，手术切缘阴性在统计学上与生存率提高相关。切缘小于5mm时，27%的患者存活且无疾病，而切缘大于5mm时这一比例为62%。证明了早期诊断、确定性手术治疗和积极辅助化疗的重要性。采用比例风险回归模型评估各种因素对无病生存和总生存的统计学意义。
