论文部分内容阅读
目的分析肢体原发成骨肉瘤综合治疗疗效,对影响局部复发的因素进行评估。方法1992年至2001年共收治术前无远处转移的肢体成骨肉瘤患者189例,平均年龄18岁,男性126例,女性63例;肿瘤部位:股骨下段86例,胫骨上段52例,四肢其他部位51例,病理骨折22例。完成化疗方案的患者为规律化疗组116例(61.4%);未完成化疗方案的患者为非规律化疗组73例(38.6%)。规律化疗组依手术方法分为保肢组90例和截肢组26例;非规律化疗组中保肢组42例和截肢组31例。采用卡方检验分别分析复发与性别、年龄、部位、病理骨折、就诊时碱性磷酸酶(AKP)值、术前化疗后 AKP 值、术前是否规律化疗、手术方式、外科边界、肿瘤大小、术后是否规律化疗、远隔转移等因素的关系。采用 Logistic 回归对复发的相关因素进行多因素分析。结果单因素卡方分析显示术前化疗后 AKP 值、手术方式、外科边界、化疗等因素与局部复发相关,而性别、年龄和部位等因素与复发相关性不显著。多因素 Logistic 回归分析显示外科边界和术前化疗后 AKP 是影响复发的两个最重要的因素。结论局部复发的发生与肿瘤的外科边界关系密切,恰当地选择外科边界可以提高保肢的安全性。局部复发与肿瘤转移高度相关,不恰当的外科治疗及化疗,危及患者的生存。
Objective To analyze the curative effect of comprehensive treatment of primary osteosarcoma in limbs and evaluate the factors that influence the local recurrence. Methods A total of 189 patients with limb osteosarcoma without distant metastasis were treated from 1992 to 2001, with a mean age of 18 years. There were 126 males and 63 females. Tumors included 86 cases of the lower femur, 52 cases of the upper tibia, 51 cases of other parts, pathological fracture in 22 cases. 116 patients (61.4%) received regular chemotherapy and 73 (38.6%) patients received non-scheduled chemotherapy. The regular chemotherapy group was divided into the limb salvage group (90 cases) and the amputation group (26 cases) according to the operation method. In the non-regular chemotherapy group, 42 cases were the salvage group and 31 cases were the amputation group. The chi square test was used to analyze the recurrence and gender, age, location, pathological fracture, AKP value, preoperative AKP value, preoperative regular chemotherapy, surgical methods, surgical border, tumor size, Whether regular chemotherapy, distant metastasis and other factors. Logistic regression was used to analyze the relapse-related factors by multivariate analysis. Results The univariate chi-square analysis showed that AKP value, surgical approach, surgical margin and chemotherapy were related to local recurrence after preoperative chemotherapy, while gender, age, location and other factors had no significant correlation with recurrence. Multivariate logistic regression analysis showed that surgical border and AKP after preoperative chemotherapy were the two most important factors affecting relapse. Conclusion The occurrence of local recurrence is closely related to the surgical boundary of the tumor. Appropriate selection of the surgical border can improve the safety of limb salvage. Local recurrence and tumor metastasis are highly correlated, inappropriate surgical treatment and chemotherapy, endangering the patient’s survival.