影响骨肉瘤生存率的多因素回归分析

摘要

Objective To investigate the factors affecting the survival rate of osteosarcoma.Methods 49 patients with osteosarcoma admitted to our hospital from May 2010 to May 2007 were included.All the patients were treated with surgical resection and chemother-apy (i.e.,Neoadjuvant chemotherapy with high -dose methotrexate +ifosfamide +adriamycin regimen before operation and Adria-mycin +cisplatin +methotrexate +ifosfamide after operation).Logistic regression analysis was applied to analyze the relative factors affecting the survival rate of patients with osteosarcoma.Results The median survival time was 42.7 months,and the 1,3,5 year sur-vival rates were 89.8%,55.1% and 36.7%,respectively.The disease -free survival rate was 30.6%.Single factor analysis showed that tumor location (P =0.021),Karnofsky (P =0.010),Enneking staging(P =0.002),operation methods (P =0.034),postopera-tive chemotherapy cycles (P =0.005)and metastasis (P =0.019)were the risk factors for survival of osteosarcoma.Multivariate anal-ysis showed that the Karnofsky function status score (P =0.026),Enneking staging(P =0.013),operation methods (P =0.037), postoperative chemotherapy cycle (P =0.006)and metastasis (P =0.029)were independent risk factors for survival.Conclusions Operation and postoperative adjuvant chemotherapy are the main methods to improve the survival rate of patients with osteosarcoma.Pre-operative evaluation of physical and tumor staging are important aspects to improve the survival rate.%目的：探讨影响骨肉瘤生存率的相关因素。方法选取该院收治的骨肉瘤患者49例。所有患者确诊后进行手术切除加化疗。术前新辅助化疗采用大剂量甲氨蝶呤＋异环磷酰胺＋阿霉素方案，术后化疗采用阿霉素＋顺铂＋甲氨蝶呤＋异环磷酰胺方案。采用 Logistic 回归分析影响骨肉瘤患者生存率的相关因素。结果患者的中位生存时间为42．7个月，1年生存率为89．8％，3年生存率为55．1％，5年生存率为36．7％，无瘤生存率为30．6％。单因素分析显示肿瘤部位（P ＝0．021）、Karnofsky 功能状态评分（P ＝0．010）、Enneking 分期（P ＝0．002）、手术方式（P ＝0．034）、术后化疗周期（P ＝0．005）和转移（P＝0．019）是影响骨肉瘤生存的危险因素。多因素分析显示 Karnofsky 功能状态评分（P ＝0．026）、Enneking 分期（P ＝0．013）、手术方式（P ＝0．037）、术后化疗周期（P ＝0．006）和转移（P ＝0．029）是影响骨肉瘤生存率的可能独立危险因素。结论手术及术后辅助化疗是提高骨肉瘤患者生存率的主要治疗方法，术前做好体力评估和肿瘤分期评估也是提高术后生存率的重要方面。