Second and Subsequent Recurrences of Osteosarcoma: Presentation, Treatment, and Outcomes of 249 Consecutive Cooperative Osteosarcoma Study Group Patients
Second and Subsequent Recurrences of Osteosarcoma: Presentation, Treatment, and Outcomes of 249 Consecutive Cooperative Osteosarcoma Study Group Patients
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DOI：
10.1200/jco.2008.16.2305
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发表时间：
2009-02-01
影响因子：
45.3
通讯作者：
Juergens, Heribert
中科院分区：
文献类型：
--
作者：
Bielack, Stefan S.;Kempf-Bielack, Beate;Juergens, Heribert
PurposeTo评估患者和肿瘤的特点，治疗，并在一个大的队列骨肉瘤复发的第二次和随后的复发，患者和Methods249名连续患者谁最初接受了新辅助合作骨肉瘤研究组协议的综合治疗，并继续发展，共409第二次和随后的骨肉瘤复发进行了分析，为患者，结果5年总体和无事件生存率分别为16%和9%，249秒，14%和0%，93第三，13%和6%，38第四，18%和0%，14第五复发，分别。随着复发次数的增加，局限于肺部的复发比例下降，胸壁受累的比例增加。无复发间期的持续时间和复发时的病灶数量与预后相关。虽然205例复发患者中只有1例在未手术缓解的情况下存活了5年，但119例第二次复发患者的5年总生存率和无事件生存率分别为32%和18%，45例第三次复发患者的5年总生存率和无事件生存率分别为26%和0%，20例第四次复发患者的5年总生存率和无事件生存率分别为28%和13%，5例第五次复发患者的5年总生存率和无事件生存率分别为53%和0%，其中再次手术缓解。化疗的使用与无手术缓解的患者的生存期延长相关。ConclusionTo我们所知，这是第一次报告的生存估计来自大队列的骨肉瘤患者的第二次和随后的骨肉瘤复发。它证实了手术清除的压倒性重要性。复发后的预后指标类似于首次复发的那些已知指标。再次化疗的确切作用，特别是在辅助情况下，仍有待确定。
PurposeTo evaluate patient and tumor characteristics, treatment, and outcomes in a large cohort of unselected patients with second and subsequent recurrences of osteosarcoma.Patients and MethodsTwo hundred forty-nine consecutive patients who had originally received combined-modality therapy on neoadjuvant Cooperative Osteosarcoma Study Group protocols and went on to develop a total of 409 second and subsequent osteosarcoma recurrences were analyzed for patient-, tumor-, and treatment-related factors and outcomes.ResultsFive-year overall and event-free survival rates were 16% and 9% for 249 second, 14% and 0% for 93 third, 13% and 6% for 38 fourth, and 18% and 0% for 14 fifth recurrences, respectively. The proportion of recurrences confined to the lungs decreased and the proportion of those with chest wall involvement increased with increasing numbers of recurrences. The duration of relapse-free intervals and the number of lesions at recurrence correlated with outcomes. While only one of 205 patients with rerecurrence survived past 5 years without surgical remission, 5-year overall and event-free survival rates were 32% and 18% for 119 second, 26% and 0% for 45 third, 28% and 13% for 20 fourth, and 53% and 0% for five fifth recurrences, respectively, in which a renewed surgical remission was achieved. The use of chemotherapy correlated with longer survival in patients without surgical remissions.ConclusionTo our knowledge, this is the first report of survival estimates derived from large cohorts of unselected patients with second and subsequent osteosarcoma recurrences. It confirms the overwhelming importance of surgical clearance. Prognostic indicators after rerecurrences resemble those known from first recurrence. The exact role of re-treatment with chemotherapy, particularly in the adjuvant situation, remains to be defined.