多药大剂量联合化疗干预骨肉瘤生存期的临床研究

目的探讨多药大剂量联合化疗对骨肉瘤患者生存期的影响及其预后相关因素。方法回顾性总结63例骨肉瘤患者的临床资料,分析多药大剂量联合化疗甲氨蝶呤(methotrexate,MTX)-MTX-顺铂(cisplatin,DDP)-多柔比星(doxorubicin,又名adriamycin,ADM)方案与MTX-异环磷酰胺(ifosfamide,IFO)-DDP-ADM方案]对患者生存期的影响及其预后相关因素。结果 63例患者3年总生存率为67.7%,其中经过手术并行完整化疗4周期综合治疗者3年生存率为81.4%。完整化疗4周期后患者3年总生存率及无进展生存期均提高(P<0.05)。3年生存率与肿瘤直径、血清碱性磷酸酶水平、是否手术、化疗完整性、化疗疗效以及远处转移相关(单因素P<0.05),其中是否手术及化疗完整性为独立相关因素(多因素P<0.05)。结论含大剂量MTX多药联合化疗是有效的,骨肉瘤的有效治疗应当建立在手术及完整化疗的基础上。

Multi-drug chemotherapy with high-dose methotrexate in treatment of osteosarcoma

Objective: To evaluate the efficacy and safety of high-dose methotrexate (HD-MTX) combined with multi-drug chemotherapy for patients with ostetmarcoma. Methods: Clinical data of 63 ostetmarcoma patients treated by HD-MTX combined with multi-drug chemotherapy were retrospectively reviewed. Factors related to the survival and prognosis of patients were analyzed. Results: Three-year overall survival rate was 67.7% among 63 patients, while that for patients who completed 4 cycles of postoperative chemotherapy was 81.4% (P<0.05). Three-year overall survival rate was significantly related to tumor size, serum AKP level, surgery, complete chemotherapy course, chemotherapy efficacy, and distant metastasis (all P<0.05). Cox-model showed that surgery and complete chemotherapy course were independent prognostic factors (P<0.05). Conclusion: HD-MTX combined with multi-drug chemotherapy in treatment of osteosareoma is effective, which should be given based on surgery and complete therapeutic courses. ©, 2015, Journal of Practical Oncology, Editorial Board. All right reserved.