Kawai A, Huvos A G, Meyers P A, Healey J H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Clin Orthop Relat Res. 1998 Mar(348):196-207.
The cases of 40 patients with osteosarcoma of the pelvis treated between 1977 and 1994 were reviewed. The location of the tumor was ilium in 30 patients, ischium in four, pubis in one, and sacrum in five. Most (58%) of the tumors were of the chondroblastic subtype. Thirty patients had surgical excision of the tumors: 10 with hemipelvectomies and 20 with limb sparing procedures. A wide margin was achieved in 16 of 30 (53%) patients, including 12 of 14 who had no sacral tumor involvement. Positive margins occurred at the sacrum in 11 patients, lumbar vertebra in one, perirectal space in one, and contralateral pubic body in one. Macroscopic tumor emboli within the regional large vessels were found in seven patients. The incidence of local recurrence was 32%: 13% in wide excisions, 38% in marginal excisions, and 80% in intralesional excisions. The 1- and 5-year overall patient survivals were 73% and 34%, respectively. Patients who had a surgical excision of the primary tumor had a significantly better survival than did those treated without surgery (5-year survival; 41% and 10%, respectively). Tumor size, surgical excision of the primary tumor, surgical margin, and type of surgical procedure were the prognostic factors for patients with Stage IIB tumors.
回顾了1977年至1994年间接受治疗的40例骨盆骨肉瘤患者的病例。肿瘤位置：30例位于髂骨，4例位于坐骨，1例位于耻骨，5例位于骶骨。大多数（58%）肿瘤为软骨母细胞亚型。30例患者接受了肿瘤手术切除：10例行半骨盆切除术，20例行保肢手术。30例患者中有16例（53%）实现了广泛切缘，包括14例无骶骨肿瘤累及患者中的12例。11例患者骶骨切缘阳性，1例腰椎切缘阳性，1例直肠周围间隙切缘阳性，1例对侧耻骨体切缘阳性。7例患者在区域大血管内发现肉眼可见的肿瘤栓子。局部复发率为32%：广泛切除术后为13%，边缘切除术后为38%，病损内切除术后为80%。患者1年和5年总生存率分别为73%和34%。接受原发肿瘤手术切除的患者生存率明显高于未接受手术治疗的患者（5年生存率分别为41%和10%）。肿瘤大小、原发肿瘤手术切除、手术切缘和手术方式是IIB期肿瘤患者的预后因素。
