中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (2): 134-139.doi: 10.19401/j.cnki.1007-3639.2018.02.009

• 论著 • 上一篇    下一篇

32例颌面部骨肉瘤临床特点比较及预后影响因素分析

袁 媛,沈 赞   

  1. 上海交通大学附属第六人民医院肿瘤内科,上海 200233
  • 出版日期:2018-02-28 发布日期:2018-03-08
  • 通信作者: 沈 赞 E-mail:sshenzzan@vip.sina.com

Retrospective analysis of clinical differences and prognostic factors in 32 patients with maxillofacial osteosarcoma

YUAN Yuan, SHEN Zan   

  1. Department of Oncology, the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Published:2018-02-28 Online:2018-03-08
  • Contact: SHEN Zan E-mail: sshenzzan@vip.sina.com

摘要: 背景与目的:骨肉瘤是较常发生于青少年的间叶组织来源的恶性肿瘤。多发于四肢,较少发生于颌面部。此类骨肉瘤的治疗大多为手术切除,辅以化疗和放疗。因为较为罕见,国内报道较少。故该研究探讨影响颌面部骨肉瘤预后的相关因素。方法:回顾性分析了2010年1月—2017年1月收治的32例颌面部骨肉瘤的临床病理资料并且对预后进行随访,随访时间为7~90个月,平均为75个月,以性别、年龄、肿瘤大小、手术切缘、肿瘤的生长部位、手术方式、手术后进行辅助化疗的次数、局部复发及转移这9项因素作为变量。应用Kaplan-Meier计算并分析其生存率,应用log-rank进行单因素分析检验,应用Cox回归模型进行多因素分析,研究这些因素和患者的生存率之间的关联。结果:32例骨肉瘤患者中位总生存期(overall survival,OS)为(47.6±8.4)个月(95%CI:31.1~64.1),累计1年和2年生存率分别为84%和72%,5年生存率为44%。单因素分析结果显示,骨肉瘤的手术切缘、术后化疗与患者的复发有关。肿瘤直径、手术切缘、术后辅助化疗是影响骨肉瘤生存的因素。多因素分析结果显示,肿瘤大小、术后辅助化疗是影响颌面部骨肉瘤患者治疗预后的主要因素。其他变量差异无统计学意义。结论:颌面部骨肉瘤有独特的生物学特性和预后,手术切缘和术后辅助化疗次数是影响骨肉瘤患者预后的主要因素。

关键词: 骨肉瘤, 复发, 转移, 预后因素, 生存, Cox风险比例回归模型

Abstract: Background and purpose: Osteosarcoma is a tumor originated from mesenchymal tissue, which often occurs in teenagers. It often occurs in long bones, rarely in maxillofacial regions. The present treatment is mainly in surgery followed by chemotherapy and radiation. It is an infrequent disease and hardly reported. In this study, we compared clinical differences in 32 maxillofacial osteosarcoma patients and identified the prognostic factors in the disease. Methods: The clinical data of 32 osteosarcoma patients were retrospectively reviewed. The data covered the period from Jan. 2010 to Jan. 2017, and included sex, age, tumor site. The mean follow-up time was 75 months (ranging from 7 to 90 months). The Kaplan-Meier method was used to measure the overall survival rate. A log-rank univariate analysis was used to determine the prognostic factors related to the survival rate. The Cox model multivariate analysis was used to identify independent prognostic factors. Results: The median survival time of 32 patients in the present study was (47.6±8.4) months (95%CI: 31.1-64.1). The 1- and 2-year cumulative survival rates were 84% and 72%, respectively. The 5-year cumulative survival rate was 44%. Log-rank univariate analysis showed that the significant factors were size, surgical margin and frequency of adjuvant chemotherapy. Surgical margin and frequency of adjuvant chemotherapy were closely related to recurrence. Cox regression analysis revealed that surgical margin and frequency of adjuvant chemotherapy were the prognostic factors. Conclusions: Maxillofacial osteosarcoma has unique features and prognosis. Surgical margin and frequency of adjuvant chemotherapy were the prognostic factors in osteosarcoma.

Key words: Osteosarcoma, Relapse, Metastasis, Prognostic factors, Survival, Cox proportional hazard model