24例中老年原发性骨肉瘤的临床报道
|
摘要
目的探讨中老年原发性骨肉瘤患者的临床诊治及预后情况。方法回顾性分析24例中老年(≥40岁)原发性骨肉瘤患者的临床资料,并对患者的复发和转移情况进行随访。结果 24例患者平均年龄54岁(40～76岁),男女比例为3∶1。肿瘤位于肢体骨10例(41.7%),位于中轴骨8例(33.3%),位于骨外软组织6例(25.0%)。2例(8.3%)诊断时已出现远处转移,所有患者均接受手术治疗,其中22例行新辅助化疗方案。术后6例局部出现肿瘤复发(25.0%),9例(37.5%)诊断后出现转移,最常见的转移部位是肺部。所有患者3年无瘤生存率(disease free survival,DFS)和总体生存率(overall survival,OS)分别为41.7%和50.0%。无肿瘤转移患者3年DFS和OS分别为53.8%和76.9%。出现肿瘤转移的患者3年OS为45.5%。结论中老年患者骨肉瘤预后较差,早期诊治联合新辅助化疗有助于提高OS。
Objective To investigate the clinical diagnosis, treatment and prognosis of middle-aged and elderly patients with primary osteosarcoma. Methods The clinical data of 24 cases of primary osteosarcoma in the middle-aged and elderly(≥40 years old) were retrospectively analyzed, and the patients′ recurrence and metastasis were followed up. Results The average age of the 24 patients was 54 years(range 40-76), and the ratio of male to female was 3∶1. Tumor was located in limb bone in 10 cases(41.7%), in axial bone in 8 cases(33.3%), and in extraspinal soft tissue in 6 cases(25.0%). Two patients(8.3%) had distant metastasis at the time of diagnosis. All patients received surgical treatment, and 22 patients underwent neoadjuvant chemotherapy. Six patients(25.0%) had local tumor recurrence after operation, and 9 patients(37.5%) had metastasis. The most frequent metastatic site was lung. The 3-year disease-free survival(DFS) and overall survival(OS) rates of all patients were 41.7% and 50.0%, respectively. The 3-year DFS and OS rates of patients without tumor metastasis were 53.8% and 76.9%, respectively, while the 3-year OS rate in patients with tumor metastasis was 45.5%. Conclusion Osteosarcoma has a poor prognosis in middle-aged and elderly patients. Early diagnosis and treatment combined with neoadjuvant chemotherapy is helpful to improve OS.
Objective To investigate the clinical diagnosis, treatment and prognosis of middle-aged and elderly patients with primary osteosarcoma. Methods The clinical data of 24 cases of primary osteosarcoma in the middle-aged and elderly(≥40 years old) were retrospectively analyzed, and the patients′ recurrence and metastasis were followed up. Results The average age of the 24 patients was 54 years(range 40-76), and the ratio of male to female was 3∶1. Tumor was located in limb bone in 10 cases(41.7%), in axial bone in 8 cases(33.3%), and in extraspinal soft tissue in 6 cases(25.0%). Two patients(8.3%) had distant metastasis at the time of diagnosis. All patients received surgical treatment, and 22 patients underwent neoadjuvant chemotherapy. Six patients(25.0%) had local tumor recurrence after operation, and 9 patients(37.5%) had metastasis. The most frequent metastatic site was lung. The 3-year disease-free survival(DFS) and overall survival(OS) rates of all patients were 41.7% and 50.0%, respectively. The 3-year DFS and OS rates of patients without tumor metastasis were 53.8% and 76.9%, respectively, while the 3-year OS rate in patients with tumor metastasis was 45.5%. Conclusion Osteosarcoma has a poor prognosis in middle-aged and elderly patients. Early diagnosis and treatment combined with neoadjuvant chemotherapy is helpful to improve OS.
引文
[1] Ek ET,Ojaimi J,Kitagawa Y,et al.Outcome of patients with osteosarcoma over 40 years of age:is angiogenesis a marker of survival?[J].Int Semin Surg Oncol,2006,(3):7.
[2] Mirabello L,Troisi RJ,Savage SA.Osteosarcoma incidence and survival rates from 1973 to 2004:Data from the Surveillance,Epidemiology,and End Results Program[J].Cancer,2009,115(7):1531-1543.
[3] Imtiaz S,Kazmi A.Patterns of care and outcomes of adult osteosarcoma in a tertiary care cancer centre in Pakistan[J].J Pak Med Assoc,2014,64(10):1166-1170.
[4] 唐顺,郭卫,杨荣利,等.40岁以上成年骨肉瘤患者的外科治疗及预后因素[J].北京大学学报:医学版,2015,47(1):165-169.
[5] Mirabello L,Troisi RJ,Savage SA.International osteosarcoma incidence patterns in children and adolescents,middle ages and elderly persons[J].Int J Cancer,2009,125(1):229-234.
[6] Song WS,Kong CB,Jeon DG,et al.Prognosis of extremity osteosarcoma in patients aged 40-60 years:A cohort/case controlled study at a single institute[J].Eur J Surg Oncol,2010,36 (5):483-488.
[7] 史景丽,沈丹华.成人原发性骨肉瘤的临床病理特征:98例30岁以上患者的报告[J].肿瘤,2015,35(8):883-888.
[8] Jaffe N.Recent advances in the chemotherapy of metastatic osteogenic sarcoma[J].Cancer,1972,30 (6):1627-1631.
[9] Link MP,Goorin AM,Miser AW,et al.The effect of adjuvant chemotherapy on relapsefree survival in patients with osteosarcoma of the extremity[J].N Engl J Med,1986,314 (25):1600-1606.
[10] 王倩荣,吴晋,刘文超,等,老年骨肉瘤患者的临床特征与预后[J].中国骨与关节杂志,2017,6(2):92-95.
[11] 王广宇,王金成,刘鹏.骨肉瘤的治疗方法[J].中国老年学杂志,2014,34(9):2604-2606.
[12] Bacci G,Ferrari S,Mercuri M,et al.Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41-60 years:outcome in 34 cases treated with adriamycin,cisplatinum and ifosfamide between 1984 and 1999[J].Acta Orthop,2007,78 (3):377-384.
[13] 祁伟祥,何爱娜,汤丽娜,等.成人骨肉瘤52例预后因素的COX比例风险模型分析[J].肿瘤,2011,31(9):846-850.
[2] Mirabello L,Troisi RJ,Savage SA.Osteosarcoma incidence and survival rates from 1973 to 2004:Data from the Surveillance,Epidemiology,and End Results Program[J].Cancer,2009,115(7):1531-1543.
[3] Imtiaz S,Kazmi A.Patterns of care and outcomes of adult osteosarcoma in a tertiary care cancer centre in Pakistan[J].J Pak Med Assoc,2014,64(10):1166-1170.
[4] 唐顺,郭卫,杨荣利,等.40岁以上成年骨肉瘤患者的外科治疗及预后因素[J].北京大学学报:医学版,2015,47(1):165-169.
[5] Mirabello L,Troisi RJ,Savage SA.International osteosarcoma incidence patterns in children and adolescents,middle ages and elderly persons[J].Int J Cancer,2009,125(1):229-234.
[6] Song WS,Kong CB,Jeon DG,et al.Prognosis of extremity osteosarcoma in patients aged 40-60 years:A cohort/case controlled study at a single institute[J].Eur J Surg Oncol,2010,36 (5):483-488.
[7] 史景丽,沈丹华.成人原发性骨肉瘤的临床病理特征:98例30岁以上患者的报告[J].肿瘤,2015,35(8):883-888.
[8] Jaffe N.Recent advances in the chemotherapy of metastatic osteogenic sarcoma[J].Cancer,1972,30 (6):1627-1631.
[9] Link MP,Goorin AM,Miser AW,et al.The effect of adjuvant chemotherapy on relapsefree survival in patients with osteosarcoma of the extremity[J].N Engl J Med,1986,314 (25):1600-1606.
[10] 王倩荣,吴晋,刘文超,等,老年骨肉瘤患者的临床特征与预后[J].中国骨与关节杂志,2017,6(2):92-95.
[11] 王广宇,王金成,刘鹏.骨肉瘤的治疗方法[J].中国老年学杂志,2014,34(9):2604-2606.
[12] Bacci G,Ferrari S,Mercuri M,et al.Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41-60 years:outcome in 34 cases treated with adriamycin,cisplatinum and ifosfamide between 1984 and 1999[J].Acta Orthop,2007,78 (3):377-384.
[13] 祁伟祥,何爱娜,汤丽娜,等.成人骨肉瘤52例预后因素的COX比例风险模型分析[J].肿瘤,2011,31(9):846-850.