Adjuvant chemotherapy of high-grade osteosarcoma of the extremity. Updated results of the Multi-Institutional Osteosarcoma Study.
Adjuvant chemotherapy of high-grade osteosarcoma of the extremity. Updated results of the Multi-Institutional Osteosarcoma Study.
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DOI：
10.1097/00003086-199109000-00003
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发表时间：
1991-09
影响因子：
4.2
通讯作者：
M. Link;A. Goorin;M. Horowitz;W. Meyer;J. Belasco;A. Baker;A. Ayala;J. Shuster
中科院分区：
文献类型：
--
作者：
M. Link;A. Goorin;M. Horowitz;W. Meyer;J. Belasco;A. Baker;A. Ayala;J. Shuster
多机构骨肉瘤研究(MIOS)旨在确定与同期对照相比，强化多药辅助化疗是否能改善四肢非转移性高级别骨肉瘤患者的预后。在确定了原发肿瘤的手术后，患者被随机分配到立即辅助化疗或不进行辅助治疗的观察。这项试验的最新结果表明，对照组的预计六年无事件存活率为11%，而化疗组为61%(p<0.001)。在拒绝随机化但根据方案的治疗臂进行随访的患者中也观察到了类似的结果。当根据分配的治疗将随机和非随机患者汇集在一起时，对那些立即接受辅助化疗的患者有利的生存优势是明显的。对接受即刻辅助化疗的患者的预后因素的分析显示，诊断时血清乳酸脱氢酶升高是最能预测不良结局的因素。胫骨原发部位的位置预示着良好的预后。作者总结说，在过去的二十年里，四肢高级别骨肉瘤的自然病史没有改变。立即给予辅助化疗对无事件生存率有显著的有利影响，应该推荐给所有此类患者。
The Multi-Institutional Osteosarcoma Study (MIOS) was designed to determine whether intensive multiagent adjuvant chemotherapy improves the outcome of patients with nonmetastatic high-grade osteosarcoma of the extremity as compared with concurrent controls. After definitive surgery of the primary tumor, patients were randomly assigned to immediate adjuvant chemotherapy or to observation without adjuvant treatment. Updated results of this trial indicate that the projected six-year event-free survival for the control group is 11% compared to 61% for the chemotherapy group (p less than 0.001). Similar results were observed in patients who declined randomization but who were followed according to the treatment arms of the protocol. When randomized and nonrandomized patients are pooled according to assigned treatment, a survival advantage favoring those patients treated with immediate adjuvant chemotherapy is apparent. An analysis of prognostic factors among patients receiving immediate adjuvant chemotherapy reveals that elevation of the serum lactic dehydrogenase at diagnosis is the factor most predictive of adverse outcome. Location of the primary site in the tibia confers a favorable prognosis. The authors conclude that the natural history of high-grade osteosarcoma of the extremity has not changed over the past two decades. The administration of immediate adjuvant chemotherapy has a significant favorable impact on event-free survival and should be recommended for all such patients.