整块切除与分块切除治疗骶骨软骨肉瘤的预后分析

Prognosis analysis for the surgical treatment of sacral chondrosarcoma: en-bloc resection versus in?鄄tralesional excision

中文关键词:  软骨肉瘤  骶骨  整块切除  分块切除  生存率

英文关键词:Chondrosarcoma  Sacral  En bloc resection  Intralesional excision  Survival rate

中文摘要:

  【摘要】 目的：比较不同手术方式对骶骨软骨肉瘤患者预后的影响。方法：回顾性分析1999年10月～2012年12月间收治的38例骶骨软骨肉瘤患者的临床资料，男20例，女18例；平均年龄42.5岁。除1例骶骨间叶型软骨肉瘤患者放弃治疗外，余37例患者均接受手术治疗，其中12例患者接受整块切除手术，25例患者接受分块切除手术。将术后出现肿瘤局部复发或远处转移定义为疾病进展并计算其发生率；应用Kaplan-Meier法测算术后生存率、无病生存率；应用Log-rank检验对手术方式与术后生存期、无病生存期的关系进行分析；应用χ2检验比较不同手术方式术后并发症发生率；应用独立样本t检验比较不同手术方式的术中出血量。结果：研究共纳入34例具有完整随访资料的骶骨软骨肉瘤患者，随访时间平均29.7个月（4～136个月），至末次随访时共12例死亡（35.3%），19例复发（58.8%），1例发生转移（2.94%）。应用Kaplan-Meier法测算术后总生存期平均为87.0±11.3个月，术后1年、2年、5年总生存率分别为82.2%、68.6%和59.4%；无病生存期平均为48.5±11.8个月，术后1年、2年、5年无病生存率分别为52.6%、48.6%和25.5%。整块切除组与分块切除组的疾病进展发生率分别为27.3%和73.9%。整块切除能够更有效地改善骶骨软骨肉瘤患者的无病生存率（P<0.05），其术后并发症发生率以及术中出血量与分块切除相比均无显著性差异（P＞0.05）。结论：与分块切除比较，整块切除能够有效改善骶骨软骨肉瘤患者的预后，同时其手术安全性亦令人满意，可作为骶骨软骨肉瘤患者的首选手术方式。

英文摘要:

  【Abstract】 Objectives: To compare surgical outcome and prognosis of en bloc resection and intralesional excisionfor sacral chondrosarcoma. Methods: 38 patients treated in our hospital from October 1999 to December 2012, including 20 males and 18 females with a mean age of 42.5 years were reviewed retrospectively. Except of 1 patient with mesenchymal chondrosarcoma who abandoned therapy, 37 of 38 patients underwent surgery. En bloc resection and intralesional excision was performed in 12 and 25 patients, respectively. To calculate the incidence of disease-progression of patients who suffered from local recurrence or distant metastasis. The survival and disease-free survival were analyzed by Kaplan-Meier survival curve. The Log-Rank test, chi-square test and independent sample t test were used to compare the influence of different surgery procedures to the prognosis, incidence of postoperative complications and perioperative blood loss, respectively. Results: 34 patients with completed data were enrolled in the research, with an average follow-up time of 29.7 months (4-136 months). 12 patients died(35.3%), 19 patients suffered from local recurrence(58.8%) and 1 patient had lung metastasis(2.94%). The average postoperative overall survival was 87.0±11.3 months. The 1, 2 and 5-year overall survival rate was 82.2%, 68.6% and 59.4%, respectively. The disease-free survival was 48.5±11.8 months. The 1, 2 and 5-year disease-free survival rate was 52.6%, 48.6% and 25.5%, respectively. The incidence of disease-progression in en bloc group and intralesional group was 27.3% and 73.9%, respectively. En bloc resection improved disease-free survival of patients significantly(P<0.05) without elevating incidence of postoperative complications and perioperative blood loss(P＞0.05). Conclusions: En bloc resection is an effective and secure surgical option for sacral chondrosarcoma.