王巍等

[摘要] 目的 观察并探讨新辅助化疗联合保肢手术治疗四肢骨肉瘤的近远期效果。方法 入选2007年7月～2011年2月辽宁省肿瘤医院66例四肢骨肉瘤行保肢术患者为研究对象，分为观察组（34例）与对照组（32例），观察组采用新辅助化疗+保肢手术+术后辅助化疗方案，对照组采用保肢手术+术后辅助化疗方案，对比两组化疗期间毒性反应、治疗半年后肢体功能及3年生存率。 结果 治疗结束后6个月，观察组肢体功能Enneking评分[（25.7±3.1）分]高于对照组[（24.2±2.8）分]，差异有统计学意义（t=2.059，P=0.044）；观察组优良率（70.6%）高于对照组（53.1%），差异无统计学意义（χ2=2.136，P=0.144）。两组化疗期间毒副作用级别以Ⅰ～Ⅱ级为主，Ⅲ级少见，Ⅳ级罕见，毒副作用发生率差异无统计学意义（P > 0.05）。化疗结束后随访36个月，观察组平均生存时间[（33.3±0.9）个月]长于对照组[（29.8±1.3）个月]，差异有统计学意义（t=12.924，P < 0.001）。观察组3年生存率（73.5%）高于对照组（56.3%），差异均无统计学意义（χ2=2.168，P=0.141）。两组总体生存时间分布差异无统计学意义（χ2=2.856，P=0.091）。 结论 新辅助化疗联合保肢术较之单纯保肢术治疗四肢骨肉瘤至少能在不明显增加化疗毒副作用基础上，改善肢体功能，并表现出延长术后生存时间与远期生存率的趋势。

[关键词] 骨肉瘤；新辅助化疗；保肢手术；肢体功能；生存率

[中图分类号] R738.1 [文献标识码] A [文章编号] 1673-7210（2014）09（a）-0039-05

[Abstract] Objective To observe and explore short and long term clinical efficacy of neoadjuvant chemotherapy combined with limb salvage operation in treatment of extremity osteosarcoma. Methods 66 osteosarcoma cases underwent limb salvage surgery from July 2007 to February 2011 were enrolled as research objects， and divided into observation group （34 cases） and control group （32 cases）， observation group was applied with neoadjuvant chemotherapy combined with limb salvage operation and postoperative adjuvant chemotherapy， control group was given limb salvage operation and postoperative adjuvant chemotherapy， toxicities of chemotherapy， limb function after treatment for 6 months and 3 year survival rate were compared between two groups. Results 6 months after the end of treatment， limb function Enneking score of the observation group [（25.7±3.1） scores] was higher than that of the control group [（24.2±2.8） scores]， the difference was statistically significant （t=2.059， P=0.044）； the excellent and good rate of observation group （70.6%） was higher than that of the control group （53.1%）， no statistically significant difference （χ2=2.136， P=0.144）. Toxicity level of two groups during chemotherapy focused on gradeⅠ and gradeⅡ， grade Ⅲ was less， grade Ⅳ was rare， and toxicity rate of two groups had no significant difference （P > 0.05）. After 36 months follow-up， the mean survival time of observation group [（33.3±0.9） months] was longer than control group [（29.8±1.3） months]， the difference was statistically significant （t=12.924， P < 0.001）. 3 years survival rate of observation group （73.5%） was higher than control group （56.3%）， the difference was not statistically significant （χ2=2.168， P =0.141）. Difference on survival time distribution of two groups had no significant difference （χ2=2.856， P=0.091）. Conclusion The neoadjuvant chemotherapy combined with limb salvage surgery compared with limb salvage surgery only for osteosarcoma at least can not increase the toxicities of chemotherapy， whilst improve physical function， and show the trend of prolong postoperative survival time and long-term survival rate.

[Key words] Osteosarcoma； Neoadjuvant chemotherapy； Limb salvage operation； Limb function； Survival rate

骨肉瘤是原发性骨恶性肿瘤，多发于股骨远端、胫骨和肱骨近端的干骺端[1]，X线下可见受累骨干骺端溶骨性及成骨性损害。骨肉瘤恶性程度较高，既往标准治疗方法是截肢术，术后3年无瘤生存率虽已上升到60%～70%[2]，但截肢后患者的生存功能与生活质量显著下降。近年来，保肢术为主的综合治疗方案逐步被患者与临床医生接受，有学者通过COX生存分析显示：术前化疗是影响骨肉瘤患者预后的独立相关因素[3]。笔者采用术前辅助化疗联合保肢手术治疗四肢骨肉瘤，并对近远期临床疗效进行了前瞻性随机对照研究，现将研究结果报道如下：