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目的探讨AP化疗方案联合手术治疗四肢原发性骨肉瘤的临床效果。方法回顾2008年1月至2011年11月,收治的四肢原发性骨肉瘤30例,病例资料及随访完整的20例患者纳入本研究,男12例,女8例;年龄9~38岁,平均19岁。发病部位:股骨远端10例,胫骨近端7例,肱骨近端3例。根据Enneking外科分期均为ⅡB期,术前穿刺活检病理亚型:成骨细胞型8例,成软骨细胞型6例,成纤维细胞型2例,小细胞性2例,毛细血管扩张型2例。20例患者均采用AP化疗方案联合手术治疗。结果随访时间12~55个月,平均35.6个月。20例中,保肢手术病例18例,截肢手术病例2例,手术即时保肢率为90%。7例因肺转移而死亡,其中5例死于术后2年内;2例分别在术后10、12个月复发,复发率为10%,末次随访时1例死亡,1例带瘤生存。Kaplan-Meier分析患者3年总生存率为66%。末次随访时规范化疗组12例中死亡3例,生存率为75%(9/12);不规范化疗组8例中死亡4例,生存率为50%(4/8)。13例存活并保留肢体的患者末次随访时MSTS评分为23~27分,平均25.3分。结论 AP化疗方案联合手术治疗四肢原发性骨肉瘤患者生存率和保肢率尚可,可以作为一种选择性应用的骨肉瘤化疗方案。
Objective To investigate the clinical effects of AP chemotherapy combined with surgical treatment of primary osteosarcoma in limbs. Methods From January 2008 to November 2011, 30 cases of primary osteosarcoma of the extremities admitted from January 2008 to November 2011 were enrolled. Twenty patients with complete follow-up were enrolled in this study. There were 12 males and 8 females, aged 9-38 years, Average 19 years old. Pathogenesis: 10 cases of distal femur, 7 cases of proximal tibia, proximal humerus in 3 cases. According to Enneking surgical staging were stage Ⅱ B, preoperative biopsy pathology subtype: 8 cases of osteoblast type, chondroblast 6 cases, fibroblast type 2 cases, 2 cases of small cell, 2 cases of telangiectasia . Twenty patients were treated with AP chemotherapy combined with surgery. Results The follow-up time ranged from 12 to 55 months with an average of 35.6 months. In 20 cases, there were 18 cases of limb salvage surgery and 2 cases of amputation surgery. The immediate limb salvage rate was 90%. Seven patients died of pulmonary metastasis, of which 5 died within 2 years after operation. Two patients relapsed 10 and 12 months postoperatively, respectively. The recurrence rate was 10%. One patient died at the last follow-up and one patient survived. The 3-year overall survival was 66% with Kaplan-Meier analysis. At the last follow-up, 3 of 12 patients died of chemotherapy in the standard chemotherapy group, with a survival rate of 75% (9/12). In the non-standard chemotherapy group of 4 patients, 4 patients died, and the survival rate was 50% (4/8). Thirteen patients survived with limbs at the last follow-up MSTS score of 23 to 27 points, an average of 25.3 points. Conclusion AP chemotherapy combined with surgical treatment of primary osteosarcoma survival rate and limb salvage rate is acceptable, can be used as a selective application of osteosarcoma chemotherapy.