摘要
目的总结我国目前骨肉瘤流行病学特征，分析国内骨肉瘤的发病情况及治疗现状。方法回顾性分析国内7家骨肿瘤诊治中心自2000年1月至2017年2月收治的1593例骨肉瘤患者的临床资料，其中男984例，女609例，男女比例为1．62：1；年龄2～80岁，平均23．2岁。病变位于四肢骨1524例，中轴骨69例。发病部位：股骨远端706例、胫骨近端375例、肱骨远端117例，其他部位395例；中轴骨包括脊柱18例，骨盆49例，肋骨2例。1593例中膝关节周围1154例（71．0％）。在国内外数据库中检索大样本文献40篇，提取其中相关数据（性别、年龄、发病部位、初诊转移情况、肿瘤坏死率、手术方式）与本组数据采用，检验进行比较。结果发病高峰年龄为11～20岁（52．4％）；〉40岁217例（13．6％）。术前穿刺活检1111例，切开活检280例。术前活检明确诊断者1345例（96．7％，1345／1391），占全部患者的84．4％。初诊伴有转移者79例（5．0％）；术前化疗1185例（74．4％）。术前化疗以DIA方案（271例）、DIA＋MTX方案（251例）、AP方案（149例）为主；共220例依据Huvos分级评估术后病理肿瘤细胞坏死率，Ⅰ级78例，Ⅱ级105例，Ⅲ级35例，Ⅳ级2例。1299例行术后化疗（81．5％）；术后化疗方案：DIA＋MTX方案471例、DIA方案266例、AP方案98例为主；手术前后化疗方案相同379例，更改化疗方案666例。1306例行保肢手术（82．0％），术式以人工假体置换术最为常见（911例，69．8％）。国内检索出18篇大样本文献共5684例病例，男女比、年龄范围、发病高峰、发病部位与本研究相似，平均年龄较本组低1～2岁，初诊转移率较高，术前术后化疗与保肢率较低，化疗后肿瘤坏死率较好。国外检索出22篇大样本文献共12850例病例，男女比例为1．30：1，与国内数据相比女性所占比例较高，平均年龄较本组高1～2岁；膝关节周围比例较低，初诊转移率较高，术前、术后化疗率与本研究类似，化疗后肿瘤坏死率较高。结论此次调查骨肉瘤发病一般情况（性别、年龄、发病部位）与之前国内外报道均无明显差别；治疗方面术前、术后化疗率及保肢手术率较以往明显提高，化疗方案上从各种方案并存转变为以DIA＋MTX与DIA方案为主。
Objective To investigate the clinical and epidemiological characteristics of osteosarcoma in China and ana- lyze the incidence and clinical treatment of osteosarcoma. Methods The clinical data of 1 593 patients with osteosarcoma in 7 bone cancer treatment centers from January 2000 to February 2017 were analyzed.We retrieved large samples of documents in thedatabase, extracted the relevant data and compared the data with this study. SPSS 13 software was used for statistical analysis and each factor was tested by χ2. Results Of 1 593 patients, 984 were males and 609 were females. The ratio of male to female was 1.62： 1. The average age was 23.2 years （range from 3-80 years）. The peak age of onset was 11-20 years （52.4%）. There were 217 elderly patients （ 〉 40 years old）. The tumors occurred in 1 524 limbs and 69 in axial bone. The most common sites of disease were distal femur 706 cases, proximal tibia 375 cases, distal humerus 117 cases and others 395 cases. There were 1 154 cases （71%） around the knee joint. The axial bone included 18 cases of spine, 49 cases of pelvis and 2 cases of rib. Preoperative biopsy was per- formed in 1 111 cases and incisional biopsy in 280 cases. Preoperative diagnosis could be made in 1 345 cases （84.4% of all pa- tients, accounting for 96.7% of biopsy patients）. There were 79 cases with metastasis at first visit, accounting for 5%. Preoperative chemotherapy was performed in 1 185 cases （74.4%）. With the DIA preoperative chemotherapy 271 cases, DIA＋MTX 251 cases, AP 149 cases. 220 cases of tumor cell necrosis rate was evaluated after operationaccording to the Huvos classification. There were 78 cases of grade Ⅰ, 105 cases of Ⅱ grade, 35 cases of Ⅲ and 2 cases of grade Ⅳ. There were 1 299 cases undergoingpostoperative chemotherapy （81.5%）, 1 306 patients undergoinglimb salvage surgery （82%）. Thespecific operation with prosthetic replacement is the most common （911 cases, 69.8%）. The postoperative chemotherapy included DIA＋MTX regimen 471 cases, DIA regimen 266 cases and AP regimen 98 eases. Before and after the operation, 379 eases were treated with the same chemotherapy regimen and 666 cases were changed. A total of 18 large sample documents were retrieved in Chinese data base （5 684 cases）.The sex ratio, age range, peak incidence and location of the disease were similar to those of this study. The average age was 1-2 years old younger. The percentage of lung metastases associated with initial visits washigher. The rate of preoperative and postoperative chemothera- py and limb salvage waslowand the rate of tumor necrosis wasbetter after chemotherapy. A total of 22 large sample literatures were searched in foreign database （12 850 eases）. The ratio of men and women is 1.30： 1 and the proportion of women is higher than the domestic data. The average age was 1-2 years older. The ratio of the knee joint was lower. The percentage of lung metastases asso- ciated with initial visits washigher. The rate of preoperative and postoperative chemotherapy and limb salvage were similar to that of this study and the rate of tumor necrosis was better after chemotherapy. Conclusion The general situation of the incidence of osteosarcoma （sex, age, location of the disease） is not significantly different from the previous reports both at home and abroad. In the treatment, preoperative and postoperative chemotherapy rate and limb salvage surgery rate have improved significantly com- pared with the past.The chemotherapy program from the coexistence of various programs, gradually to the DIA＋MTX and DIA pro- gram as the mainstream program.
作者
王文剑
于秀淳
韩加
郑凯
徐明
胡永成
王丰
吴苏稼
流小舟
姚阳
余文熙
王臻
李明辉
张国川
赵铭
于沂阳
张伟滨
鲍其远
Wang Wenjian;Yu Xiuchun;Han Jia;ZhengKai;Xu Ming;Hu Yongcheng;Wang Feng;Wu Sujia;Liu Xiaozhou;Yao Yang;Yu Wenxi;Wang Zhen;Li Minghui;Zhang Guoch-uan;Zhao Ming;Yu Yiyang;Zhang Weibin;Bao Qiyuan(Department of Orthopedics,General Hospital of Jinan Military Commanding Region,Ji＇nan 250031,China;Department of Bone Oncology,Tianjin Hospital,Tianjin 300200,China;Department of Ortho-pedics,General Hospital of Nanjing Military Commanding Region,Nanjing 210001,China;Department of Tumor,Shanghai Sixth People＇s Hospital,Shanghai 200233,China;Department of Bone Oncology,Xifing Hospital,Xi＇an 710032,China;Department of Bone Oncology,The Third Affiliated Hospital of Hebei Medical University,Shijia-zhuang 050051,China;Department of Orthopedics,Ruijin Hospital,Shanghai 200025,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第18期1097-1107,共11页
Chinese Journal of Orthopaedics
关键词
骨肉瘤
流行病学
肿瘤治疗方案
对比研究
Osteosarcoma
Epidemiology
Antineoplastic protocols
Comparative study
