骨原发尤文肉瘤预后相关因素的分析

摘要

目的 明确骨原发尤文肉瘤患者的治疗结果,分析影响预后相关因素.方法 回顾性分析1998年7月至2007年7月就诊的78例骨原发尤文肉瘤患者的临床资料.通过随访了解肿瘤学预后,明确5年总体生存率及局部复发率.通过回顾病例,分析年龄、性别、肿瘤部位、肿瘤大小、初次诊断时有无转移、乳酸脱氢酶、碱性磷酸酶水平、治疗方式、外科边界等因素对总体生存率的影响.利用Kaplan-Meier生存分析确定对生存有影响的单个因素,并通过Cox回归分析明确影响预后的独立危险因素.结果 53例患者获得随访,中位随访时间37.6个月(8.0～101.0个月).患者5年总体生存率为33.7%,局部复发率20.8%,中位复发时间20个月.单因素分析结果显示:年龄＜20岁、初诊时元转移、病变位于四肢、肿瘤直径＜10 cm、取得广泛外科边界的患者预后较好(P＜0.05);多因素分析显示初诊时转移情况、肿瘤部位、肿瘤直径是影响预后的独立危险因素.结论 初诊时有无转移、肿瘤的部位和大小是影响骨尤文肉瘤预后的独立危险因素.%Objective To determine the prognostic factors from the view of clinic and pathology.Methods A retrospective analysis was performed on a data set of 78 patients with Ewing's sarcoma treated at Peking University People's Hospital Musculoskeletal tumor center between July 1998 and July 2007. Fiveyear overall survival(OS), reccurence rate and prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors for OS. Results Fifty-three cases were followed up, follow-up time ranged from 8.0 to 101.0 months (median 37.6 months). The 5-year overall survival rate and local reccurence rate were 33.7% and 20.8% respectively. Univariate showed age ＜20 years, metastases free at diagnosis, tumor located at extremities, tumor size ＜10 cmm, adequate surgical margin had better survival rate( all P ＜0.05). Multivariate analysis demonstrated that metastases at diagnosis, primary site and tumor size were independent prognostic factors for OS. Conclusion The independent prognostic factors Ewing's sarcoma are metastases at diagnosis, primary site,tumor size.