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.20.3.776
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发表时间：
2002-02-01
影响因子：
45.3
通讯作者：
Winkler, K
中科院分区：
文献类型：
--
作者：
Bielack, SS;Kempf-Bielack, B;Winkler, K
目的：为广泛的骨肉瘤的疗效和远期结局确定预后因素，其范围远远超出典型的年轻的看似局限于四肢疾病的患者。患者和方法：连续1702例新诊断的躯干或四肢高级别骨肉瘤患者在1998年7月之前登记在合作性骨肉瘤研究组的新辅助研究中，进入人口统计学、肿瘤相关和治疗相关的变量、反应和生存的分析。结果：单因素和多因素分析显示，轴型肿瘤部位、男性、病史长与化疗反应差有关。精算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年生存率大于或等于40，41.6%，40，60.2%，P=.012)，肿瘤部位(轴向，29.2%；肢体，61.7%；P<；0.0001)，以及原发转移(是，26.7%；否，64.4%；P<；0.0001)，以及四肢骨肉瘤，也是大小(大于或等于三分之一，52.5%；<；三分之一，66.7%；肢体位置(近端，49.3%；其他，63.9%；P<；.0001)对预后有显著影响。另外两个与治疗有关的重要预后因素是：对化疗的反应(差，47.2%；良，73.4%；P<；.0001)和手术程度(不完全，14.6%；宏观上完全，64.8%；P<；.0001)。除年龄外，所有因素在多因素检验中均有显著意义，手术缓解和组织学反应是影响骨肉瘤预后的关键因素。结论：骨肉瘤的肿瘤部位和大小、原发灶转移、化疗反应和手术缓解对预后有独立的预测价值。(C)2002年，由美国临床肿瘤学会提供。
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 greater than or equal to 40, 41.6%, < 40, 60.2%, P = .012), tumor site (axial, 29.2%; limb, 61.7%; P < .0001), and primary metastases (yes, 26.7%; no, 64.4%; P < .0001), and for extremity osteosarcomas, also size (greater than or equal to 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. (C) 2002 by American Society of Clinical Oncology.