PROGNOSIS FOR PATIENTS WHO HAVE OSTEOSARCOMA WITH SKIP METASTASIS
PROGNOSIS FOR PATIENTS WHO HAVE OSTEOSARCOMA WITH SKIP METASTASIS
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DOI：
10.2106/00004623-199072010-00010
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发表时间：
1990-01-01
影响因子：
5.3
通讯作者：
ENNEKING, WF
中科院分区：
文献类型：
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作者：
WUISMAN, P;ENNEKING, WF
我们分析了 23 名患有 IIB 期骨肉瘤并跳过转移的患者的病例，以确定无病生存率和长期生存率。术前和术后化疗方案各不相同。研究了与跳跃性病变相关的复发和长期生存模式，并将这些模式与 224 名患有 II 期骨肉瘤但无跳跃性病变的患者进行了比较。在 23 名发生跳跃性病变的患者中，22 名出现局部复发或远处转移； 22 名患者死亡，其中一名在三十八个月后仍保持无病状态。 Kaplan-Meier 分析显示，有和没有跳跃转移的患者之间，局部复发率和远处转移率（Mantel-Cox 检验统计数据，p < 0.0001）以及总生存率（Mantel-Cox 检验统计数据，p < 0.0001）存在显着差异。将 14 名股骨远端病变发生跳跃性转移的患者与 87 名原发性病变位置相似但无跳跃性转移的患者进行比较。差异是显着的，尽管比分析所有解剖部位的病变时的差异要小。随访数据表明，使用辅助化疗并不能改善皮肤转移患者的不良预后。因此，我们将皮肤病变以及区域淋巴转移或远处器官转移作为考虑骨肉瘤III期的另一个标准。
We analyzed the cases of twenty-three patients who had Stage-IIB osteosarcoma and skip metastasis to determine the rates of disease-free and long-term survival. The regimens of preoperative and post-operative chemotherapy varied. The patterns of relapse and long-term survival were studied in relation to the skip lesions, and these patterns were compared with those of 224 patients who had Stage-II osteosarcoma but no skip lesions. Of the twenty-three patients who had skip lesion, twenty-two had either a local recurrence or a distant metastasis; twenty-two patients died, and one remained disease-free at thirty-eight months. Kaplan-Meier analysis showed significant differences in the rates of local recurrence and distant metastasis (Mantel-Cox test statistic, p < 0.0001) and in the over-all survival (Mantel-Cox test statistic, p < 0.0001) between the patients who had and those who did not have skip metastasis. The case of fourteen patients who had skip metastasis from a lesion in the distal end of the femur were compared with those of eighty-seven patietns who had a similarly situated primary lesion but no skip metastasis. The difference was significant, although less so than when lesions in all anatomical sites were analyzed. The follow-up data indicated that the use of adjuvant chemotherapy did not improve the poor prognosis of patients who had skin metastasis. Therefore, we regard a skin lesion, along with regional lymphatic metastasis or metastasis to a distant organ, as another criterion for considering an osteosarcoma to be Stage III.