Does Increased Rate of Limb-sparing Surgery Affect Survival in Osteosarcoma?
Does Increased Rate of Limb-sparing Surgery Affect Survival in Osteosarcoma?
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DOI：
10.1007/s11999-010-1423-4
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发表时间：
2010-11-01
影响因子：
4.2
通讯作者：
Luis Muscolo, D.
中科院分区：
文献类型：
--
作者：
Ayerza, Miguel A.;Farfalli, German L.;Luis Muscolo, D.
背景保肢手术作为骨肉瘤患者的一种选择的出现归因于术前化疗以及肌肉骨骼成像和手术技术的进步。虽然保肢手术的适应症已经大大扩大，但保肢手术是否影响总体生存尚不清楚。问题/目的我们询问在过去的30年里，保肢手术在高级别骨肉瘤中是否有所增加，这是否会影响患者的生存和最终截肢。方法我们回顾了1980-2004年采用多学科方法治疗的251例高级别骨肉瘤患者，其中包括新辅助化疗。我们比较了三个不同时期的存活率、保肢治疗和保肢手术后的截肢情况。1980年至1989年收治53例，1990年至1999年收治97例，2000年至2004年收治101例。结果一期截肢术后5年生存率为36%，20世纪90年代为60%，2000~2004年为67%。20世纪80年代保肢率为53%(28/53)，90年代为91%(88/97)，2000-2004年为97%(98/101)。保肢组214例中有22例(10%)需要二次截肢，第一期保肢率为36%(19/53)，90年代保肢率为81%(79/97)，2000~2004年保肢率为93%(94/101)。结论后两期骨肉瘤患者保肢率较高，二次截肢率较低。
Background The emergence of limb salvage surgery as an option for patients with osteosarcoma is attributable to preoperative chemotherapy and advancements in musculoskeletal imaging and surgical technique. While the indications for limb salvage have greatly expanded it is unclear whether limb salvage affects overall survival.Questions/purposes We asked whether over the past three decades limb-sparing procedures in high-grade osteosarcoma had increased, and whether this affected survival and ultimate amputation.Methods We retrospectively reviewed 251 patients with high-grade osteosarcoma treated from 1980 to 2004 with a multidisciplinary approach, including neoadjuvant chemotherapy. We compared survival rates, limb-salvage treatment, and amputation after limb-sparing procedure during three different periods of time. Fifty-three patients were treated from 1980 to 1989, 97 from 1990 to 1999, and 101 from 2000 to 2004. Thirty-seven patients were treated with primary amputations and 214 with primary limb salvage.Results The 5-year survival rate in the first period was 36%, whereas in the 1990s, it was 60% and 67% from 2000-2004. Limb salvage surgery rate in the 1980s was 53% (28 of 53), whereas in the 1990s, it was 91% (88 of 97) and 97% from 2000-2004 (98 of 101). In the limb salvage group, 22 of the 214 patients (10%) required secondary amputation; the final limb salvage rate in the first period was 36% (19 of 53), whereas in the 1990s, it was 81% (79 of 97) and 93% from 2000-2004 (94 of 101).Conclusions Patients with osteosarcoma treated in the last two periods had higher rates of limb salvage treatment and survival, with lower secondary amputation.