WEEKLY HIGH-DOSE METHOTREXATE AND DOXORUBICIN FOR OSTEOSARCOMA - THE DANA-FARBER-CANCER-INSTITUTE THE CHILDRENS-HOSPITAL - STUDY-III
WEEKLY HIGH-DOSE METHOTREXATE AND DOXORUBICIN FOR OSTEOSARCOMA - THE DANA-FARBER-CANCER-INSTITUTE THE CHILDRENS-HOSPITAL - STUDY-III
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DOI：
10.1200/jco.1987.5.8.1178
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发表时间：
1987-08-01
影响因子：
45.3
通讯作者：
ABELSON, HT
中科院分区：
文献类型：
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作者：
GOORIN, AM;PEREZATAYDE, A;ABELSON, HT
1976年7月至1981年12月，46例诊断为四肢常规高级别非转移性骨肉瘤的患者接受每周一次高剂量甲氨蝶呤联合甲酰四氢叶酸和长春新碱（HDMTX）和多柔比星作为术后辅助治疗。原发性病变通过广泛或根治性截肢（26例患者）或在20例选定患者中通过肢体保留切除术进行治疗。切除的边缘被回顾性分类为边缘3例，宽16例，根治性1例。所有患者的5年无复发生存率（RFS）为59%（95%置信区间[CI]，43%，74%），总生存率为78%（95% CI，65%，91%）。最初接受肢体切除术的患者的RFS为55%（95% CI，32%，77%），而最初接受截肢术的患者为62%（95% CI，43%，81%）（P = 0.52）。使用多变量分析，预测RFS ≥ 100的唯一显著的预后变量是：3年时，原发肿瘤存在中度至显著的淋巴细胞浸润（P <0.002），原发部位在肱骨近端外（P <0.005），原发肿瘤中成骨细胞模式不占优势（P <0.03）。
Weekly high-dose methotrexate with leucovorin rescue and vincristine (HDMTX) and doxorubicin was administered as adjuvant postoperative therapy to 46 patients with a diagnosis of conventional high-grade nonmetastatic osteosarcoma of an extremity between July 1976 and December 1981. The primary lesions were managed by wide or radical amputation (26 patients) or by limb-sparing resection in 20 selected patients. The margins of the resections were retrospectively classified as marginal in three, wide in 16, and radical in one. The 5-year relapse-free survival (RFS) for all patients is 59% (95% confidence interval [CI], 43%, 74%) and overall survival is 78% (95% CI, 65%, 91%). The RFS for patients initially having a limb resection procedure is 55% (95% CI, 32%, 77%) compared with 62% (95% CI, 43%, 81%) for those initially having amputations (P = .52). Using multivariate analysis, the only significant prognostic variables that predicted RFS of .gtoreq. 3 years, were the presence of moderate to marked lymphocytic infiltration of the primary tumor (P < .002), primary site outside of the proximal humerus (P < .005), and the absence of a predominance of osteoblastic pattern in the primary tumor (P < .03).