摘要
目的系统评价骨肉瘤患者预后的影响因素。方法检索PubMed、EMbase、Springer、Science Direct、Wiley InterScience、ProQuest-Health&Medical Complete、EBSCO-MEDLINE、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、中文科技期刊数据库、中国期刊全文数据库。搜集骨肉瘤预后影响因素相关的大样本(病例数>100例)病例对照研究,检索时限为1980年1月1日至2017年3月1日。由2位研究者独立筛选文献、提取资料和评价纳入研究的质量,应用Review Manager 5.3软件进行Meta分析。结果共24项研究符合纳入标准,总样本量11 677例。Meta分析结果显示:男性患者5年无事件生存率(EFS)略低于女性患者[比值比(OR)=0.81,95%CI 0.71~0.93,P=0.002];青少年组(≤14岁)5年EFS较成年组略低(OR=0.77,95%CI 0.63~0.95,P=0.01);规范化疗未常规开展前,手术联合化疗组5年总生存率高于单纯手术组(OR=2.65,95%CI 1.75~4.02,P<0.000 01);规范化疗开展后,规范化疗组5年EFS高于非规范化疗组(OR=2.47,95%CI 1.64~3.73,P<0.000 01);保肢手术组5年EFS高于截肢组(OR=1.94,95%CI 1.61~2.35,P<0.000 01);化疗效果好组(Huvos分级Ⅲ、Ⅳ级)5年EFS高于化疗效果差组(Huvos分级Ⅰ、Ⅱ级)(OR=2.29,95%CI1.94~2.69,P<0.000 01);初诊无肿瘤转移组5年总生存率明显高于初诊伴转移组(OR=5.26,95%CI 3.56~7.79,P<0.000 01)。结论男性骨肉瘤患者较女性预后略差,手术联合规范化疗能明显提高患者5年EFS,保肢手术预后较好,化疗效果差与初诊伴有肿瘤转移则明显影响骨肉瘤患者预后。
Objective To systemically evaluate factors influencing theprognosis of osteosarcoma.Methods Case-control studies(sample size>100)investigating the factors influencing the prognosis of osteosarcoma published from1 st January 1980 to 1 st March2017 were searched in the databases,including PubMed,EMbase,Springer,Science Direct,Wiley InterScience,ProQuest Health & Medical Complete,EBSCO MEDLINE Complete,CNKI,CBM,Wanfang Database,China Scientific Journal Database,Chinese Journal Full-text Database.Two researchers independently selected literatures,extracted data and evaluated the quality of included studies.The meta-analysis was conducted within the Review Manager 5.3 software.Results According to the inclusion criteria,24 case-control studies with 11 677 patients were selected.Five-year event-free survival(EFS)of male patients was significantly lower than that of female patients(OR=0.81,95%CI 0.71-0.93,P=0.002).Five-year EFS of the adolescent group(≤14 years old)was slightly lower than that of the adult group(over 14 years old)(OR=0.77,95%CI 0.63-0.94,P=0.01).Before standardized chemotherapy,which was started in 2000,five-year overall survival rate of patients receiving surgery and chemotherapy was significantly higher than patients only receiving surgery(OR=2.65,95%CI 1.75-4.02,P<0.000 01).After 2000,five-year survival rate of patients receiving the standardized chemotherapy was significantly higher than those undergoing non-standardized chemotherapy(OR=2.47,95%CI 1.64-3.73,P<0.000 01).Five-year EFS of the limb-salvage surgery group was higher than that of the amputation surgery group(OR=1.94,95%CI 1.61-2.35,P<0.000 01).Five-year EFS of patients with a good response to chemotherapy(HuvosⅢ+Ⅳ)was higher than that of patients with poor response to chemotherapy(HuvosⅠ+Ⅱ)(OR=2.29,95%CI 1.94-2.69,P<0.000 01).Patients without bone metastasis had significantly better five-year overall survival rate than those with bone metastasis at the initial consultation(OR=5.26,95%CI 3.56-7.79,P<0.000 01).Conclusion The prognosis of male osteosarcoma patients was slightly worse than that of female patients.Surgery plus standardized chemotherapy can improve five-year EFS of osteosarcoma patients.Patients who had undergone limb-salvage surgery had a better prognosis.Poor response to chemotherapy and bone metastasis had a negative influence on the prognosis of osteosarcoma.
出处
《国际骨科学杂志》
2018年第1期45-53,共9页
International Journal of Orthopaedics
