Sluga M, Windhager R, Lang S, Heinzl H, Bielack S, Kotz R
Department of Orthopaedics, University of Vienna, Austria.
Clin Orthop Relat Res. 1999 Jan(358):120-7.
Limb salvage surgery in patients with osteosarcoma is reported to cause a higher rate of local recurrences with a poorer chance of survival. It was the aim of the study to analyze differences between ablative and limb sparing surgery in patients with osteosarcoma who are treated with chemotherapy with respect to local and systemic tumor control and to determine independent prognostic factors. One hundred thirty consecutive patients younger than the age of 21 years who were operated on at the authors' institution for osteosarcoma of the extremities were reviewed. Histologic evaluations of surgical margins according to Enneking and coworkers revealed mostly wide (n = 109) and radical (n = 10) resection margins. The 5-year disease free survival rate was 60% for those patients treated by amputation and 71% for those treated by limb salvage. The overall local recurrence rate was 2.3%; 4.3% for ablation but only 1.2% for limb sparing surgeries. Multivariate analysis showed an independent effect of tumor volume, response to chemotherapy, and as expected, metastases at the time of diagnosis on overall survival. These data indicate that in patients where wide or radical tumor resection can be achieved, no difference in the outcome between ablative and limb sparing surgery occurred in local and systemic tumor control.
据报道，骨肉瘤患者的保肢手术会导致局部复发率更高，生存机会更低。本研究的目的是分析接受化疗的骨肉瘤患者在进行根治性手术和保肢手术时，在局部和全身肿瘤控制方面的差异，并确定独立的预后因素。回顾了在作者所在机构接受手术的130例连续的21岁以下肢体骨肉瘤患者。根据恩内金及其同事的方法对手术切缘进行组织学评估，结果显示大多数为广泛切缘（n = 109）和根治性切缘（n = 10）。接受截肢治疗的患者5年无病生存率为60%，接受保肢治疗的患者为71%。总体局部复发率为2.3%；根治性手术为4.3%，而保肢手术仅为1.2%。多变量分析显示肿瘤体积、对化疗的反应以及正如预期的诊断时的转移情况对总生存有独立影响。这些数据表明，在能够实现广泛或根治性肿瘤切除的患者中，根治性手术和保肢手术在局部和全身肿瘤控制方面的结果没有差异。
