99例骨肉瘤肺转移患者随访结果分析

摘要

目的 了解骨肉瘤肺转移的预后情况,分析影响预后的因素.方法 回顾2000年1月至2008年7月治疗的99例骨肉瘤肺转移患者的临床资料,并对其预后进行随访,随访时间13～91个月,平均24.45个月.其中男65例,女34例;确诊时年龄7～68岁,平均20.39岁.患者均接受原发部位肿瘤切除治疗,93例患者接受新辅助化疗,6例因经济原因而未行其他辅助治疗.16例患者在就诊时即存在肺转移;47例在接受治疗期间发现肺转移,36例在随访期间发生肺转移.就发病年龄、肺转移数目、肺转移发生时段、合并其他部位的转移、原发肿瘤对化疗的反应、肺转移治疗等有可能影响预后的因素进行统计学分析.结果 从确诊骨肉瘤到发现肺转移时间为0～74个月,平均9.05个月.患者确诊骨肉瘤后的中位生存时间为25个月;累计一年、两年及五年生存率分别为87.4%、56.8%、23.4%.单因素统计分析显示骨肉瘤肺转移影响生存的有效预后因素为肺转移发生的时段及针对肺转移病灶的治疗;多因素统计分析显示肺转移发生的时段是影响预后的独立因素.其他因素如发病年龄、肺转移数目、合并其他部位的转移、原发肿瘤对化疗的反应等不具有统计学意义.结论 转移发生较晚且积极干预的骨肉瘤患者可获得较好的预后.对肺转移瘤进行积极的手术切除和辅助化疗能有效延长骨肉瘤肺转移患者的生存时间.%Objective To identify prognostic factors and imply the appropriate management of pulmonary metastases from osteosarcoma. Methods Data were obtained retrospectively from 99 osteosarcoma patients with pulmonary metastases who received systemic treatments and followed up in Department of Orthopedic Oncology of Peking University People's Hospital from January 2000 to July 2008. The mean followup time was 24.45 months (range, 13-91 months). The average age of the patients at diagnosis was 20.39 years (range, 7-68 years); the male female ratio was 65:34. All the patients had undergone resection of tumors, and 93 of them had received neoadjuvant chemotherapy. Pulmonary metastases were found in 16 patients at diagnosis of osteosarcoma, in 47 patients during chemotherapy and 36 patients after the whole treatment. The age of patients, the number of pulmonary metastases, the time of appearance of pulmonary metastases,extrapulmonary metastases, the response of primary tumor to chemotherapy and management of pulmonary metastases were analyzed. Results The interval between the diagnosis of osteosarcoma and pulmonary metastases ranged from 0 to 74 months with the mean time of 9.05 months. The 1-year, 2- and 5-year cumulative survival rates were 87.4%, 56.8% and 23.4% respectively in the study, with the median survival time of 25 months. Univariate analysis showed the significant factors included the time of appearance and the management of pulmonary metastases. Cox regression analysis revealed that the time of appearance of pulmonary metastases was the only prognostic factor. There was no significant difference between age, number of pulmonary metastases, extrapulmonary metastases and response of primary tumor to chemotherapy.Conclusion Characteristics related to the time of appearance of pulmonary metastases and surgical management especially as pulmonary resection appear to be more predictive of a successful outcome.