Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols.
Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols.
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DOI：
10.1200/jco.2002.20.3.776
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发表时间：
2002-02
期刊：
影响因子：
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通讯作者：
S. Bielack;B. Kempf‐Bielack;G. Delling;G. Exner;S. Flege;K. Helmke;R. Kotz;M. Salzer‐Kuntschik-M.-Salzer‐Kuntschi
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文献类型：
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作者：
S. Bielack;B. Kempf‐Bielack;G. Delling;G. Exner;S. Flege;K. Helmke;R. Kotz;M. Salzer‐Kuntschik-M.-Salzer‐Kuntschi
目的：确定广泛骨肉瘤的反应和长期预后的预后因素，这些骨肉瘤远远超出了那些典型的年轻患者，这些患者似乎患有局限性肢体疾病。患者和方法：1998年7月之前，共有1,702例新诊断的躯干或四肢高级别骨肉瘤患者登记入骨肉瘤合作研究组的新辅助治疗研究，这些患者被纳入人口统计学、肿瘤相关和治疗相关变量、反应和生存分析。预期的治疗策略包括术前和术后多种药物化疗以及所有可手术病灶的手术治疗。结果单因素和多因素分析显示，肿瘤轴位、男性和长期症状史与化疗反应差相关。10年总生存率和无事件生存率分别为59.8%和48.9%。在诊断时可评估的变量中，患者年龄（精算10年生存率≥ 40，41.6%; ≥ 1/3，52.5%; <1/3，66.7%; P <.0001）和肢体内位置（近端，49.3%;其他，63.9%; P <.0001）对预后有显著影响。另外两个重要的预后因素与治疗相关：化疗反应（差，47.2%;好，73.4%; P <.0001）和手术范围（不完全，14.6%;大体完整，64.8%; P <.0001）。除年龄外的所有因素在多变量检验中均保持其显著性，手术缓解和组织学反应是关键的预后因素。结论肿瘤部位、大小、原发转移、化疗反应及手术缓解是影响骨肉瘤预后的独立因素。
PURPOSE To define prognostic factors for response and long-term outcome for a wide spectrum of osteosarcomas, extending well beyond those of the typical young patient with seemingly localized extremity disease. PATIENTS AND METHODS A total of 1,702 consecutive newly diagnosed patients with high-grade osteosarcoma of the trunk or limbs registered into the neoadjuvant studies of the Cooperative Osteosarcoma Study Group before July 1998 were entered into an analysis of demographic, tumor-related, and treatment-related variables, response, and survival. The intended therapeutic strategy included preoperative and postoperative chemotherapy with multiple agents as well as surgery of all operable lesions. RESULTS Axial tumor site, male sex, and a long history of symptoms were associated with poor response to chemotherapy in univariate and multivariate analysis. Actuarial 10-year overall and event-free survival rates were 59.8% and 48.9%. Among the variables assessable at diagnosis, patient age (actuarial 10-year survival > or = 40, 41.6%; or = one third, 52.5%; < one third, 66.7%; P <.0001) and location within the limb (proximal, 49.3%; other, 63.9%; P <.0001), had significant influence on outcome. Two additional important prognostic factors were treatment related: response to chemotherapy (poor, 47.2%; good, 73.4%; P <.0001) and the extent of surgery (incomplete, 14.6%; macroscopically complete, 64.8%; P <.0001). All factors except age maintained their significance in multivariate testing, with surgical remission and histologic response emerging as the key prognostic factors. CONCLUSION Tumor site and size, primary metastases, response to chemotherapy, and surgical remission are of independent prognostic value in osteosarcoma.