Lindner N J, Scarborough M T, Spanier S S, Enneking W F
Department of Orthopedics at the University of Florida, College of Medicine, Gainesville 32610, USA.
J Cancer Res Clin Oncol. 1998;124(10):575-80. doi: 10.1007/s004320050217.
The necrotic effect of chemotherapy on primary osteosarcoma has been shown to be predictive of the final outcome. Little attention has been paid to the local response of the host (LHR), which reflects the tumour-host relationship.
A four-step grading system was developed based on distinct histological patterns of the LHR around the lesion. These responses were correlated with the chemotherapy-induced necrosis or chemosensitivity and analysed in an attempt to ascertain their influence on the patient prognosis. The ability of conventional radiographs and computed tomography to measure LHR was studied.
The grading system was applied to macroslides of specimens obtained from 72 patients with stage II B primary osteosarcoma in various limbs after wide resection and complete courses of pre- and postoperative chemotherapy who were treated between 1985 and 1991 with a median follow-up of 5 years and 9 months. The histological specimens were blindly reviewed by two pathologists and two experienced musculoskeletal oncologists to assign a grade of response. The results were correlated with tumour necrosis, patient survival and response features on conventional radiographs and CT images.
Significant correlation was found between LHR and tumour necrosis or chemosensitivity (r=0.55) and between LHR and CT response (r=0.56). There was no correlation between LHR and the findings on conventional radiographs. A grade 4 LHR was predictive of long-term survival.
The LHR to preoperative chemotherapy has a prognostic influence on patient survival and can be predicted by CT.
化疗对原发性骨肉瘤的坏死效应已被证明可预测最终结果。但反映肿瘤与宿主关系的宿主局部反应（LHR）却很少受到关注。
基于病变周围LHR的不同组织学模式开发了一种四步分级系统。将这些反应与化疗诱导的坏死或化疗敏感性相关联，并进行分析以确定它们对患者预后的影响。研究了传统X线片和计算机断层扫描测量LHR的能力。
该分级系统应用于1985年至1991年间接受治疗的72例II B期原发性骨肉瘤患者的标本大体切片，这些患者位于四肢不同部位，接受了广泛切除及术前和术后完整疗程的化疗，中位随访时间为5年9个月。由两名病理学家和两名经验丰富的肌肉骨骼肿瘤学家对组织学标本进行盲法评估以确定反应等级。将结果与肿瘤坏死、患者生存率以及传统X线片和CT图像上的反应特征相关联。
发现LHR与肿瘤坏死或化疗敏感性之间存在显著相关性（r = 0.55），LHR与CT反应之间也存在显著相关性（r = 0.56）。LHR与传统X线片的表现之间无相关性。4级LHR可预测长期生存。
术前化疗的LHR对患者生存具有预后影响，并且可以通过CT进行预测。
