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目的探讨术前新辅助化疗次数、区域动脉灌注化疗对骨肉瘤临床近期疗效及预后的影响。方法术前无远处转移的ⅡB期肢体骨肉瘤随访95例,随机分为新辅助化疗组和术后辅助化疗组。新辅助化疗组51例,其中加用动脉灌注化疗17例。新辅助化疗组术前化疗1～3个疗程,主要药物为MTX、DDP、IFO、EPI,动脉灌注化疗加用顺铂和表阿霉素灌注化疗1次。评价新辅助化疗组、术后辅助化疗组、新辅助化疗组中加用动脉灌注组间的疗效差异。结果随访满2年的79例患者中位生存期为53.0个月(95%CI1 8.08～87.92),无病中位生存期为17.0个月(95%CI9.33～24.67)。新辅助化疗组的中位无病生存时间及中位生存时间均高于术后辅助化疗组,两组生存函数差异有统计学意义。加用灌注化疗的患者保肢率81.25%,远高于不加灌注化疗者,差异有统计学意义。结论新辅助化疗的实施提高了ⅡB期骨肉瘤患者的2年无病生存率及总生存率。是改善ⅡB期骨肉瘤患者预后的理想方法。动脉灌注化疗可以增加保肢几率,改善近期疗效,但对患者的远期生存影响无统计学意义。
Objective To investigate the effect of preoperative neoadjuvant chemotherapy and regional arterial infusion chemotherapy on the clinical efficacy and prognosis of osteosarcoma. Methods A total of 95 patients with stage ⅡB limb osteosarcoma without distant metastasis were randomly divided into neoadjuvant chemotherapy group and postoperative adjuvant chemotherapy group. Neoadjuvant chemotherapy group of 51 cases, including arterial infusion chemotherapy in 17 cases. Neoadjuvant chemotherapy group preoperative chemotherapy 1 to 3 courses, the main drug for MTX, DDP, IFO, EPI, arterial infusion chemotherapy plus cisplatin and epirubicin perfusion chemotherapy 1. To evaluate the differences between the neoadjuvant chemotherapy group, postoperative adjuvant chemotherapy group and neoadjuvant chemotherapy group with arterial infusion group. Results The median survival of 79 patients who were followed up for 2 years was 53.0 months (95% CI1 8.08 ~ 87.92). The median disease-free survival was 17.0 months (95% CI 9.33 ~ 24.67). The median duration of disease-free survival and median survival time of neoadjuvant chemotherapy group were higher than that of postoperative adjuvant chemotherapy group, and the difference of survival function between the two groups was statistically significant. Plus infusion chemotherapy in patients with limb salvage rate of 81.25%, much higher than those without perfusion chemotherapy, the difference was statistically significant. Conclusion The implementation of neoadjuvant chemotherapy improves the 2-year disease-free survival rate and overall survival rate of patients with stage IIB osteosarcoma. Is to improve the prognosis of stage Ⅱ B osteosarcoma patients an ideal way. Arterial infusion chemotherapy can increase the probability of limb salvage, improve the short-term efficacy, but the impact on the long-term survival of patients was not statistically significant.