摘要
目的通过对54例骨与软组织恶性肿瘤肺转移术后随访,探讨转移灶手术治疗的中期疗效及影响预后的主要临床因素。方法从骨肿瘤肺转移随访数据库中接受肺转移灶完整切除的54例中,随访其术后无进展生存率(progression-free survival rate,PFS)及总生存率(overall survival rate,OS),并根据患者临床病理特征进行生存分析,寻找其主要影响因素。结果本组患者发生肺转移后,2年和5年无进展生存率分别为(61.7±7.1)%和(24.6±8.1)%,2年和5年总生存率分别为(88.8±4.8)%和(43.1±14.5)%,疗效满意。单因素分析显示转移灶数量(P=0.016)和转移部位(P=0.037)与预后有显著关系,累及肺野(P=0.056)接近显著。年龄、性别、肺外转移、转移时间、使用靶向药物等因素均无显著差异。多因素分析仅双肺转移为独立预后影响因素。其中7例在围手术期使用靶向药物新辅助治疗,趋势上减少了术后早期肺转移灶复发的发生率,差异无统计学意义(P=0.16)。结论骨与软组织肉瘤肺转移手术治疗中期疗效较为理想,双肺转移是其独立的影响因素。靶向治疗作为转移灶新辅助治疗的临床价值值得进一步探索。
Objective To investigate the mid-term prognosis and main clinical factors affecting prognosis in 54 cases of bone and soft tissue sarcoma with lung metastases.Methods A total of 54 patients who underwent complete resection of lung metastasis were enrolled from the follow-up database of bone and soft tissue sarcoma with lung metastasis.The postoperative progression-free survival rate(PFS),overall survival rate(OS),and patient’s clinical pathological characteristics were followed-up for survival analysis,aiming to find out the main influencing factors.Results The 2-year and 5-year PFS after lung metastasis were(61.7±7.1)%and(24.6±8.1)%,respectively.The 2-year and 5-year OS were(88.8±4.8)%and(43.1±14.5)%,respectively.The prognosis was satisfactory.Univariate analysis showed that the number of metastasis(P=0.016)and metastatic site(P=0.037)were significantly associated with prognosis,and the involvement of the lung(P=0.056)was nearly significant.There were no significant differences in factors such as age,gender,extrapulmonary metastasis,metastasis time,and use of targeted drugs.Multivariate analysis showed that only bilateral lung metastasis was the independent prognostic factor.Seven patients were treated with neoadjuvant therapy with targeted drugs perioperatively,and the trend was reduced in the incidence of early postoperative lung metastasis,but with no statistical differences(P=0.16).Conclusions Treatment of bone and soft tissue sarcoma with lung metastasis is ideal for the mid-term.Bilateral lung metastasis is an independent influencing factor.Clinical value of targeted therapy,as a neoadjuvant therapy for metastases,deserves further exploration.
作者
杨孝清
鲍其远
朱良纲
张伟滨
沈宇辉
YANG Xiao-qing;BAO Qi-yuan;ZHU Liang-gang;ZHANG Wei-bin(Department of Orthopedics,Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,Shanghai,200025,China)
出处
《中国骨与关节杂志》
CAS
2019年第9期676-680,共5页
Chinese Journal of Bone and Joint
基金
国际医学交流基金会国家创新药重点监测专项科研基金(Z-2018-32-180030)
希思科-恒瑞肿瘤研究基金(Y-HR2017-028)
关键词
骨肿瘤
外科手术
分子靶向治疗
预后
肺转移
Bone neoplasms
Surgical procedures,operative
Molecular targeted therapy
Prognosis
Lung metastasis
