中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (2): 132-137.doi: 10.19438/j.cjoms.2021.02.007

• 论著 • 上一篇    下一篇

新辅助化疗治疗头颈部骨肉瘤单中心临床效果回顾

戴振霖1#, 艾哈迈德·阿德热罕穆1#, 陈一铭1, 汪轶2,*, 季彤1,*   

  1. 1.上海交通大学医学院附属第九人民医院·口腔医学院 口腔颌面-头颈肿瘤科,
    2.口腔综合科,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海 200011
  • 收稿日期:2020-03-10 修回日期:2020-06-04 出版日期:2021-03-20 发布日期:2021-05-11
  • 通讯作者: 季彤,E-mail: jitongjitong@foxmail.com;汪轶,E-mail: realwangyi@sina.com。*共同通信作者
  • 作者简介:戴振霖（1995-）,男,硕士,E-mail: zhenlin_dai@outlook.com;艾哈迈德·阿德热罕穆（1980-）,男,博士,E-mail: cmf.abdelrehem@yahoo.com。#并列第一作者
  • 基金资助:
    申康医院发展中心新兴前沿项目（SHDC22017101）; 上海交通大学医学院附属第九人民医院生物样本库项目（YBKB201908）

Neoadjuvant chemotherapy in head and neck osteosarcoma: a retrospective study in single institute

DAI Zhen-lin1, AHMED·Abdelrehem1, CHEN Yi-ming1, WANG Yi2, JI Tong1   

  1. 1. Department of Oromaxillofacial Head and Neck Oncology,
    2. Department of General Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Disease; Shanghai Key Laboratory of Stomatology & Shanghai Institute of Stomatology. Shanghai 200011, China
  • Received:2020-03-10 Revised:2020-06-04 Online:2021-03-20 Published:2021-05-11

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摘要： 目的 评价新辅助化疗在头颈部骨肉瘤治疗中的效果。方法 回顾2007—2015年于上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科接受治疗的头颈部骨肉瘤患者的基本信息、围术期治疗信息、影像学信息、病理学信息以及随访记录,采用SPSS 17.0软件包对数据进行统计学分析。结果 最终纳入患者157例,男68例,女89例,5年总生存率（OS）为50.96%。≤30岁51例,31~60岁85例,≥61岁21例。91例肿瘤位于下颌骨,66例位于上颌骨及颅底。高级别骨肉瘤141例,低级别骨肉瘤8例,分化程度未知8例。54例肿瘤最大直径>4 cm,103例肿瘤直径≤4 cm。术区切缘阳性7例。单纯手术治疗65例,手术联合化疗15例,手术联合放、化疗23例,手术及放疗54例。单因素分析显示,肿瘤远处转移的相关因素为上颌骨及颅底肿瘤（P=0.022）、高级别骨肉瘤（P=0.011）以及阳性切缘（P=0.031）;下颌骨骨肉瘤（P=0.032）、阴性切缘（P=0.006）与患者OS相关;阴性切缘（P=0.007）与患者无瘤生存率（DFS）相关。多因素分析显示,肿瘤部位（P=0.034）、切缘（P=0.006）、化疗（P=0.025）、病理学亚型（P=0.012）与患者总体生存率相关;阳性切缘（P=0.002）、未接受放疗（P=0.005）与肿瘤局部复发相关。结论 术区安全切缘是头颈部骨肉瘤良好预后的关键,放疗在一定程度上可以抑制肿瘤复发,化疗（新辅助化疗、辅助化疗）可提高患者术后总体生存状况。

关键词: 头颈部, 骨肉瘤, 新辅助化疗, 预后

Abstract: PURPOSE: To analyze the outcome of neoadjuvant chemotherapy in the treatment of head and neck osteosarcoma. METHODS: A retrospective study of head and neck osteosarcoma patients treated from 2007 to 2015 was conducted. The clinical, radiological, pathological, treatment information and follow-up records were collected. Statistical analysis was performed with SPSS 17.0 software package. RESULTS: One hundred and fifty-seven patients were included, with a 5-year overall survival rate (OS) of 50.96%. Sixty-eight were male, 89 were female. Fifty-one were aged less than 30 years old, 85 were within 31-60 years old, 21 were more than 61 years old. Ninety-one had tumor in the mandible while 66 in the maxilla and skull base. One hundred and forty-one were high-grade osteosarcoma, 8 were low-grade osteosarcoma, 8 were unknown differentiated. Fifty-four had tumor > 4 cm and 103 ≤4 cm in diameter. Seven had positive surgical margin. Sixty-five were treated with surgery alone, 15 had surgery and chemotherapy, 23 had surgery combined with chemoradiotherapy, 54 had surgery and radiotherapy. Univariate analysis showed that distant metastasis were related with maxillary and skull base tumors (P=0.022), high-grade osteosarcoma (P=0.011) and positive margin (P=0.031). Osteosarcoma of the mandible(P=0.032), negative margin (P=0.006) were correlated with overall survival. Surgical margin (P=0.007) was associated with disease free survival. Multivariate analysis showed that tumor region (P=0.034), surgical margin (P=0.006), chemotherapy (P=0.025) and pathological subtype (P=0.012) were correlated with OS. Positive margin (P=0.002) and without adjuvant radiotherapy(P=0.005) were associated with local recurrence. CONCLUSIONS: Negative surgical margin is important for good prognosis. Chemotherapy (neoadjuvant chemotherapy and adjuvant chemotherapy) can improve the OS of patients with head and neck osteosarcoma

Key words: Head and neck, Osteosarcoma, Neoadjuvant chemotherapy, Prognosis

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