骨肉瘤的治疗及生存率的多因素分析
骨肉瘤,,骨肉瘤；,生存因素；,化学疗法,1材料和方法,2结果,3讨论,参考文献：
摘 要：[目的]探讨影响四肢骨肉瘤患者生存的因素，分析手术联合化疗的疗效。[方法]统计分析骨肉瘤患者84例，其中男52例，女32例；年龄9~47岁，平均21岁。股骨42例，胫骨29例，肱骨13例。ⅡA期22例，ⅡB期62例。骨母细胞型47例，软骨母细胞型11例，纤维母细胞型19例，混合型7例。根据是否接受化疗分为两组，化疗组46例，非化疗组38例。手术方法：保肢组49例，截肢组35例。用Cox模型，卡方检验进行统计学处理。[结果]全部病例随访6～74个月，平均225个月。经Cox模型分析：年龄、性别、部位、病理分型对预后影响不大，化疗有利于生存(P=00 001，=-1720 467)，ⅡB期肿瘤预后比ⅡA期差(P=00 639，=1107 901)。经卡方检验：化疗组的肺转移率(5435%)和非化疗组的肺转移率(947%)差异有显著性意义(P<0005)。化疗保肢组的局部复发率(1714%)和非化疗组的局部复发率(5714%)之间的差别有显著性意义(P<0005)。化疗保肢率(7609%)和非化疗保肢率(3500%)之间的差别有显著性意义(P<0005)。[结论]肿瘤外科分期、是否接受化疗是影响骨肉瘤治疗预后的主要因素。化疗可以降低肺转移率、局部复发率、提高保肢率，从而提高骨肉瘤患者的生存率及生活质量。关键词：骨肉瘤； 生存因素； 化学疗法
Treatments and the multiple factors analysis of surviving rate of extremity osteosarcom∥GUO Quanyi,LU Shibi,ZHANG Li,et alInstitute of Orthopaedics,General Hospital of Chinese Peoples Liberation Army,Beijing 100853
Abstract：[Objective]To analyze factors related with surviving rate and to evaluate effectiveness of the adjuvant chemotherapy in the treatment of osteosareoma[Method]Eightyfour patients aging from 9 to 47 years(averaged,21 years)were analysed respectively:52 of them were male and 32 were femaleThe tumors were located at the femur in 42,the tibia in 29,the humerus in 13There were 22 patients classified as stage ⅡA and 62 patients as ⅡBThe pathological study,of subtype of osteosarcoma revealed that 47 were osteoblastic,11 chondroblastic,19 fibroblastic and 7 other subtypesThere were 46 patients who received the chemotherapy;38 patients without chemotherapy,49 of the 84 patients treated surgically had limb salvage procedures,35 had amputationsMultivariate analsis was done by using the proportional hazards model of Cox,categoric data were analyzed by using the chisquare statistic[Result]All cases were followed up from 6 to 74 months(with an average of 255 months)Cox model analysis showed that age,sex,site,and subtype were not significant prognostic variables in this group of patients;the significant affecting prognosis in patients was Enncking staging and chemotherapyChisquare showed significant difference in the higher metastasis rates of lung in the group without chemotherapy than in those with chemotherapy group(P<0005)In the limb salvage groups,the rccurrence rate was lower in chemotherapy group than in those without chemotherapy(P<0005),the limb salvage rate was higher in chemotherapy group than in those without chemotherapy(P<0005)[Conclusion]The significant factors affecting prognosis in patients are the Enneking staging and the chemotherapy;the chemotherapy plays an import role in increasing survival rates and quality of livingThe surgical operation combined with the chemotherapy is an ideal treatment method for the exteremity osteosarcomas ......
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