关键词: 骨肉瘤, 颌骨, 影像学, 病理学, 预后分析

Abstract: PURPOSE: To investigate the clinical, imaging and prognosis of osteosarcoma of the jaw. METHODS: A total of 25 patients with osteosarcoma of the jaw confirmed by pathology and relevant preoperative examinations were collected from Xuzhou Central Hospital from January 2015 to December 2021. The clinical and imaging findings of the patients were summarized, and the factors influencing the prognosis of the patients were analyzed. SPSS 25.0 software package was used for data analysis. RESULTS: The male and female ratio of osteosarcoma of jaw was 9∶16, but there was no significant difference in gender and age distribution of osteosarcoma of jaw. The incidence of osteosarcoma in maxilla and mandible was 11∶14, involving zygomatic bone in 2 cases. The main clinical symptoms were maxillofacial mass/swelling, followed by numbness or pain. A total of 19 patients were followed up, including 11 negative surgical margins and 8 positive ones. Six cases(32%) had no recurrence and no metastasis, 11 cases(57%) had local recurrence with/without distant metastasis, and 2 cases(11%) had only distant metastasis. The most common site of metastasis was the lung, followed by the thoracolumbar spine. Plain CT showed bone destruction, continuous/discontinuous cortical bone (6∶19), with or without periosteum reaction (18∶7), with/without soft tissue mass formation (20∶5), with/without tumor bone formation (17∶8). Enhanced CT showed annular enhancement at the edge of the soft tissue mass but no enhancement at the center. MRI showed slightly low signal intensity in the bone destruction area and soft tissue mass on T1WI, equal or high signal intensity on T2WI, unclear signal of bone cortex, fluid accumulation along the edge of jaw bone, unclear boundary with adjacent muscle space. Prognostic analysis showed that there was significant difference in surgical margin status between maxillary osteosarcoma and mandibular osteosarcoma (P=0.024), and there was significant difference in the influence of surgical margin status on postoperative recurrence/metastasis of patients (P=0.018). CONCLUSIONS: The main clinical manifestations of osteosarcoma of jaw bone were maxillofacial mass/swelling, followed by numbness or pain. The diagnosis of osteosarcoma of the jaw can be indicated when the bone destruction of the jaw is accompanied by soft tissue mass and tumor bone formation, and the mass has obvious circular enhancement at the edge and no central enhancement. The location of osteosarcoma of jaw bone affected the status of surgical margin, and the status of surgical margin had significant influence on postoperative recurrence/metastasis.

Key words: Osteosarcoma, Jaws, Imaging, Pathology, Prognostic analysis