Resection of recurrent pulmonary metastases in patients with osteosarcoma
Resection of recurrent pulmonary metastases in patients with osteosarcoma
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DOI：
10.1002/cncr.21369
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发表时间：
2005-10-15
期刊：
影响因子：
6.2
通讯作者：
Mercuri, M
中科院分区：
文献类型：
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作者：
Briccoli, A;Rocca, M;Mercuri, M
背景资料。外科手术切除肺转移瘤在骨肉瘤患者中被广泛接受。关于复发性肺转移瘤的治疗数据很少。本研究的作者对因复发肺转移而接受手术治疗的骨肉瘤患者进行了回顾性分析。方法：从1980年到2001年，共对94名患者进行了127次肺转移切除术。合格标准为无肺外转移、无局部复发、转移灶完全切除而不导致呼吸功能不全、可接受的手术风险。数据处理采用Kaplan-Meier单因素分析、生命表和Gehan统计模型进行生存分析，多因素分析采用Cox回归检验。结果94例患者中，59例(62.7%)死亡，死亡59例(62.7%)。35人(37.3%)还活着；其中31人(32.9%)一直没有患病。第一次转移瘤切除术的3年和5年无事件精算生存率曲线分别为45%和38%，而第二次转移瘤切除术的3年和5年无事件精算生存率曲线分别为33%和32%。根据COX回归模型，每多活一个月，DFI1的死亡风险是0.974倍，DFI2的死亡风险是0.972倍。在多因素分析中，COX回归检验显示局部复发和转移数目的最佳预测模型(P=0.0014)。结论：作者得出结论：持续无原发骨肉瘤、发展为可切除肺转移疾病的患者应考虑第二次、第三次或第四次手术，因为这些患者五年后的DFI曲线相似。
BACKGROUND. Surgical resection of lung metastases is widely accepted in osteosarcoma patients. Few data exist on treatment of recurrent pulmonary metastases. The authors of the current study retrospectively analyzed patients with osteosarcoma who received surgery for recurrent lung metastases.METHODS. From 1980 to 2001, 127 metastasectomies were performed on 94 patients. Criteria of eligibility were no metastases beyond the lung, no local recurrence, possibility of achieving complete resection of metastases without causing respiratory insufficiency, acceptable operative risk. Data were statistically elaborated with survival analysis according to Kaplan-Meier method of univariate analysis, life tables and Gehan statistic model, and multivariate analysis using Cox regression test. Results were considered in terms of time from first (DFI1) and second (DFI2) metastasectomy.RESULTS. Of 94 patients operated upon twice, 59 (62.7%) died. Thirty-five (37.3%) are alive; 31 (32.9%) of these are continuously disease-free. The 3- and 5-year event-free actuarial survival curve from first metastasectomy was 45%, and 38%, respectively, whereas from the second metastasectomy, it was 33% and 32%, respectively. According to a Cox regression model, DFI1 has a risk of death of 0.974 times and DFI2 of 0.972 times for every additional month of survival. In multivariate analysis, Cox regression test showed the best predictive model of local recurrence and number of metastases (P = 0.0014).CONCLUSIONS. The authors concluded that patients persistently free of the primary osteosarcoma who developed recurrent resectable metastatic disease of the lung should be considered for reoperation a second, third, or fourth time, as these patients had similar DFI curves after five-years.