Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma
Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma
复制标题
DOI：
10.2106/00004623-200005000-00007
复制
发表时间：
2000-05-01
影响因子：
5.3
通讯作者：
Widhe, T
中科院分区：
文献类型：
--
作者：
Widhe, B;Widhe, T
背景：骨肉瘤和尤文氏肉瘤的初始症状和正确诊断和治疗之间的时间较长。在过去的二十年里，由于新的化疗方案，这些疾病患者的预后得到了显着改善。因此，保肢手术已成为截肢的替代方案。本研究的目的是建立最初的症状和体征的骨肉瘤和尤文肉瘤的记录的第一次医疗访问，并确定早期的疾病特征，以缩短延迟diagnosis.Methods：一组患者骨肉瘤或尤文肉瘤被确定为从瑞典癌症登记的患者30岁及以下。获得了102例骨肉瘤患者和47例尤文肉瘤患者因骨肿瘤相关症状首次就诊的记录，结果：87例患者报告了与紧张相关的疼痛（85%）的骨肉瘤患者和30（64%）的尤文肉瘤，但只有21（21%）的骨肉瘤患者和9（19%）的尤文肉瘤患者报告夜间疼痛，48%（47%）的骨肉瘤患者和12%（26%）的尤文肉瘤患者将症状的发作与同一时间发生的轻微创伤相关。初次就诊时，40例（39%）骨肉瘤患者和16例（34%）尤文肉瘤患者出现可触及的肿块，大多数情况下怀疑肿瘤诊断。误诊的范围很广;最常见的是肌腱炎，这是32例患者的初步诊断。（31%）的骨肉瘤患者和10（21%）的尤文肉瘤患者，医生的延误尤文肉瘤的发病时间（从首次出现症状到确诊的时间）比骨肉瘤长（分别为19周和9周; p < 0.0001）。结论：骨肉瘤和尤文肉瘤的初始症状都是疼痛，这是间歇性的，通常与紧张有关，但在夜间不经常感觉到。创伤史是常见的，但临床过程往往偏离预期的创伤。骨肉瘤尤其是尤文氏肉瘤的临床过程不是稳定的进展，而是间歇性的，这常常使医生误认为这种情况是暂时的。最重要的临床特征是可触及的肿块，超过三分之一的患者在首次就诊时就发现了这种肿块。这一发现强调了彻底的身体检查是绝对必要的。
Background: The time between the initial symptoms of osteosarcoma and Ewing sarcoma and the correct diagnosis and treatment is long. Over the last two decades, the prognosis for patients with these diseases has dramatically improved due to a new chemotherapy regimen. As a consequence, a limb-sparing operation has become an alternative to amputation. The aim of this study was to establish the initial symptoms and physical signs of osteosarcoma and Ewing sarcoma from the records of the first medical visit and to identify early characteristics of the diseases to shorten the delay to diagnosis.Methods: A group of patients with osteosarcoma or Ewing sarcoma was identified from the Swedish Cancer Register of patients thirty years old and younger. Records from the first medical visit due to symptoms related to the bone tumor were obtained for 102 patients with osteosarcoma and forty-seven patients with Ewing sarcoma,Results: Pain related to strain was reported by eighty-seven (85 percent) of the patients with osteosarcoma and thirty (64 percent) of those with Ewing sarcoma, but only twenty-one (21 percent) of the patients with osteosarcoma and nine (19 percent) of those with Ewing sarcoma reported pain at night, Forty-eight (47 percent) of the patients with osteosarcoma and twelve (26 percent) of those with Ewing sarcoma related the onset of symptoms to minor trauma occurring around the same time. A palpable mass was noted in forty (39 percent) of the patients with osteosarcoma and sixteen (34 percent) of those with Ewing sarcoma at the first visit, and in most cases the tumor diagnosis was suspected. There was a broad spectrum of misdiagnoses; the most common was tendinitis, which was the initial diagnosis in thirty-two (31 percent) of the patients with osteosarcoma and ten (21 percent) of those with Ewing sarcoma, The doctor's delay (the period from the first medical visit due to the symptoms to the correct diagnosis) was longer for Ewing sarcoma than for osteosarcoma (nineteen weeks and nine weeks, respectively; p < 0.0001),Conclusions: An initial symptom of both osteosarcoma and Ewing sarcoma was pain, which was intermittent and often related to strain but not frequently felt at night. A history of trauma was common, but the clinical course often diverged from what was expected from trauma. The clinical course of osteosarcoma and particularly of Ewing sarcoma was not steadily progressive but intermittent, which often misled the doctor into believing that the condition was temporary, The most important clinical feature was a palpable mass, which was noted in more than one-third of the patients at the first visit. This finding emphasizes that a thorough physical examination is absolutely necessary.