Primary metastatic osteosarcoma:: Presentation and outcome of patients treated on neoadjuvant cooperative osteosarcoma study group protocols
Primary metastatic osteosarcoma:: Presentation and outcome of patients treated on neoadjuvant cooperative osteosarcoma study group protocols
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DOI：
10.1200/jco.2003.08.132
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发表时间：
2003-05-15
影响因子：
45.3
通讯作者：
Bielack, SS
中科院分区：
文献类型：
--
作者：
Kager, L;Zoubek, A;Bielack, SS
目的：确定人口统计学数据，并确定在初次就诊时临床可检测到转移的高级别骨肉瘤患者长期预后的预后因素。在1999年之前新辅助治疗骨肉瘤合作研究组研究中登记的1,765例新诊断的、先前未经治疗的高级别骨肉瘤患者中，202例患者（11.4%）在诊断时已证实转移，因此被纳入人口统计学、肿瘤和治疗相关变量、缓解和生存分析。预期的治疗策略包括术前和术后的多药化疗以及积极的手术切除的所有lesions.Results：平均随访1.9年（5.5年的幸存者），60例患者存活，其中37人在连续完全手术缓解。5年和10年（15年相同）的精算总生存率分别为29%（SE = 3%）和24%（SE = 4%）。在单因素分析中，生存率与患者年龄、原发肿瘤的部位、转移的数量和位置、累及器官系统的数量、原发肿瘤对术前化疗的组织学反应以及所有肿瘤部位的手术切除的完整性和时间点显著相关。然而，在多变量考克斯回归分析后，只有多个转移在诊断（相对风险率[RHR] = 2.3）和肉眼不完全手术切除（RHR = 2.4）仍然与较差的结果显著相关。诊断时的转移灶数量和所有临床检测到的肿瘤部位的手术切除完整性对证实为原发性肝癌的患者具有独立的预后价值。转移性骨肉瘤(C)2003年，美国临床肿瘤学会。
Purpose: To determine demographic data and define prognostic factors for long-term outcome in patients presenting with high-grade osteosarcoma of bone with clinically detectable metastases at initial presentation.Patients and Methods: Of 1,765 patients with newly diagnosed, previously untreated high-grade osteosarcomas of bone registered in the neoadjuvant Cooperative Osteosarcoma Study Group studies before 1999, 202 patients (11.4%) had proven metastases at diagnosis and therefore were enrolled onto an analysis of demographic-, tumor-, and treatment-related variables, response, and survival. The intended therapeutic strategy included pre- and postoperative multiagent chemotherapy as well as aggressive surgery of all resectable lesions.Results: With a median follow-up of 1.9 years (5.5 years for survivors), 60 patients were alive, 37 of whom were in continuously complete surgical remission. Actuarial overall survival rates at 5 and 10 (same value for 15) years were 29% (SE = 3%) and 24% (SE = 4%), respectively. in univariate analysis, survival was significantly correlated with patient age, site of the primary tumor, number and location of metastases, number of involved organ systems, histologic response of the primary tumor to preoperative chemotherapy, and completeness and time point of surgical resection of all tumor sites. However, after multivariate Cox regression analysis, only multiple metastases at diagnosis (relative hazard rate [RHR] = 2.3) and macroscopically incomplete surgical resection (RHR = 2.4) remained significantly associated with inferior outcomes.Conclusion: The number of metastases at diagnosis and the completeness of surgical resection of all clinically detected tumor sites are of independent prognostic value in patients with proven primary metastatic osteosarcoma. (C) 2003 by American Society of Clinical Oncology.