Picci P, Böhling T, Bacci G, Ferrari S, Sangiorgi L, Mercuri M, Ruggieri P, Manfrini M, Ferraro A, Casadei R, Benassi M S, Mancini A F, Rosito P, Cazzola A, Barbieri E, Tienghi A, Brach del Prever A, Comandone A, Bacchini P, Bertoni F
Department of Pathology, Rizzoli Orthopedic Institute, Bologna, Italy.
J Clin Oncol. 1997 Apr;15(4):1553-9. doi: 10.1200/JCO.1997.15.4.1553.
This study was performed to assess the prognostic value of the proposed histopathologic method to evaluate the response of the primary tumor to preoperative chemotherapy in Ewing's sarcoma.
The response to chemotherapy was evaluated from the specimens of 118 Ewing's sarcoma patients, who were preoperatively treated by chemotherapy alone. Responses were graded I to III (macroscopic viable tumor, microscopic viable tumor, and no viable tumor cells, respectively). Follow-up data were available for all patients, with a mean follow-up duration of 86 months (range, 30 to 158).
A statistically highly significant difference was observed in outcome among the three groups of patients. For patients with total necrosis (grade III response), the estimated 5-year disease-free survival rate was 95%, in contrast to 68% for grade II responders and 34% for grade III responders (P < .0001). This difference was also confirmed when any single group was compared with the other groups. Among the parameters tested, patient age and the size of tumor had some prognostic value.
The proposed histopathologic grading, to evaluate the effect of chemotherapy on the primary tumor, had the strongest correlation to clinical outcome. This method could therefore be used to identify patients with a high risk of recurrent disease. These patients could be randomized to receive alternative postoperative treatments to investigate whether more aggressive therapies will improve outcome.
本研究旨在评估所提出的组织病理学方法对评估尤因肉瘤原发肿瘤对术前化疗反应的预后价值。
对118例仅接受术前化疗的尤因肉瘤患者的标本进行化疗反应评估。反应分为I至III级（分别为肉眼可见存活肿瘤、显微镜下可见存活肿瘤和无存活肿瘤细胞）。所有患者均有随访数据，平均随访时间为86个月（范围30至158个月）。
三组患者的预后存在统计学上的高度显著差异。对于完全坏死（III级反应）的患者，估计5年无病生存率为95%，而II级反应者为68%，I级反应者为34%（P <.0001）。当任何一组与其他组进行比较时，这种差异也得到了证实。在所测试的参数中，患者年龄和肿瘤大小具有一定的预后价值。
所提出的用于评估化疗对原发肿瘤效果的组织病理学分级与临床结果的相关性最强。因此，该方法可用于识别疾病复发风险高的患者。这些患者可随机接受替代术后治疗，以研究更积极的治疗方法是否会改善预后。
