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目的分析新辅助化疗及保肢治疗对长期生存儿童骨肉瘤患者心理行为及生存质量的影响。方法回顾分析1999年12月～2005年11月应用新辅助化疗及保肢治疗的25例儿童骨肉瘤患者。男11例,女14例,平均年龄12岁(5～16岁)。股骨远端17例,胫骨近端7例,肱骨近端1例。Enneking外科分期均为IIB期。对所有患者进行随访,计算5年无瘤生存率,对长期生存的13例患者参照MSTS93评分标准进行患肢功能评价,采用90项自觉症状自评量表(SCL-90)和中文版医学结局研究简明调查表(SF-36)进行心理行为与生存质量评估。结果25例患者术后中位随访时间21个月(12～120个月),5年无瘤生存率为44.0%。13例长期生存的患者MSTS93评分平均21.6分(14～29分),优良率为69.2%;SCL-90量表各因子分均值在1.46～2.31之间,其中人际关系、躯体化、焦虑、恐怖得分均高于常模(P<0.05);SF-36量表显示患者活力、总体健康、生理功能得分较低,其生存质量各维度得分由大到小依次为情感职能、社会功能、精神健康、生理职能、躯体疼痛、生理功能、总体健康、活力。结论骨肉瘤新辅助化疗及保肢治疗可使患儿获得较高的长期生存率,但对患者心理行为和生存质量产生了一定程度的影响,提示需要加强骨肉瘤患儿的心理支持,提高患儿生存质量。
Objective To analyze the effect of neoadjuvant chemotherapy and limb salvage therapy on psychological behavior and quality of life in long-term survival children with osteosarcoma. Methods A retrospective analysis of 25 children with osteosarcoma treated with neoadjuvant chemotherapy and limb salvage from December 1999 to November 2005 was performed. There were 11 males and 14 females, with an average age of 12 years (5-16 years). 17 cases of distal femur, 7 cases of proximal tibia, proximal humerus in 1 case. Enneking surgical staging is stage IIB. All patients were followed up to calculate the 5-year disease-free survival rate. Thirteen patients with long-term survival were evaluated for the function of the limbs according to the MSTS93 score. Ninety-nine symptoms of self-rating Symptoms Scale (SCL-90) and Chinese medical outcomes Study Concise Questionnaire (SF-36) for psychological behavior and quality of life assessment. Results The median follow-up time of 25 patients was 21 months (range, 12 to 120 months). The 5-year disease-free survival rate was 44.0%. MSTS93 score was 21.6 points (14-29) in 13 patients with long-term survival, the excellent and good rate was 69.2%. The means of SCL-90 subscales were between 1.46 and 2.31, including interpersonal relationship, somatization, anxiety and horror Score of SF-36 was lower than that of norm (P <0.05). SF-36 showed lower vitality, general health and lower score of physical function, and all dimensions of quality of life were emotional function, social function, mental health , Physiological Function, Somatic Pain, Physiological Function, General Health, Vitality. Conclusions Neoadjuvant chemotherapy and limb salvage treatment of osteosarcoma can make children obtain higher long-term survival rate, but have a certain degree of impact on the psychological behavior and quality of life of patients, suggesting that the need to strengthen the psychological support of children with osteosarcoma, improve the risk of Children’s quality of life.