股骨原发未分化多形性肉瘤保肢治疗临床观察

Clinical observation of limb salvage therapy for primary undifferentiated pleomorphic sarcoma of the femur

摘要:

［目的］ 观察手术联合化疗保肢治疗股骨原发未分化多形性肉瘤患者术后短期临床疗效。［方法］ 回顾性分析本科 2015 年 10 月—2019 年 10 月病理诊断为股骨原发未分化多形性肉瘤的 10 例患者临床资料。Enneking 外科分期：IIA 期 1 例，IIB 期 9 例。术前接受新辅助化疗者 4 例，术后化疗者 8 例。手术为肿瘤髋关节重建 1 例，节段型假体重建 1 例，肿瘤膝关节重建 8 例。按国际骨与软组织肿瘤协会 （MSTS） 评分系统评价术后功能情况。［结果］所有患者均顺利完成手术，无伤口不愈合及伤口周围感染，无下肢深静脉血栓发生。全部患者均获随访 7~43 个月，平均（25.10±14.18）个月。4 例死亡，1 例带瘤存活，5 例无瘤存活。5 例术后出现转移，肿瘤转移平均时间（4.40±1.14）个月，2 例局部复发。术后 3 个月下肢 MSTS 评分平均（26.50±1.58）分。［结论］ 新辅助化疗在部分病例并非必须，广泛边界手术切除和化疗能够获得疾病局部控制，病理性骨折及化疗不敏感患者术后复发及转移可能性较大，保肢治疗下肢功能恢复满意。

Abstract:

[Objective] To observe the short-term clinical outcomes of surgery combined with chemotherapy for primary undifferentiat- ed pleomorphic sarcoma of the femur. [Methods] A retrospective study was done on 10 patients who received surgery combined with chemo- therapy for primary undifferentiated pleomorphic sarcoma of the femur diagnosed by biopsy from October 2015 to October 2019 in our de- partment. The tumor was of Enneking Stage IIA in 1 case and Stage IIB in 9 cases. Of them, 4 patients received preoperative neoadjuvant chemotherapy and 8 patients had postoperative chemotherapy conducted, and all patients received surgical treatment, including broad boundary surgical resection with hip reconstruction by prostheses for tumor in 1 case, segmental prosthetic reconstruction in 1 case, and knee reconstruction by prostheses for tumor in 8 cases. Postoperative function was assessed according to Musculoskeletal Tumor Society (MSTS) scoring system. [Results] All patients were successfully operated on without wound nonunion, infection around wound, and deep ve- nous thrombosis of lower limbs. All patients were followed up for 7~43 months, with a mean of (25.10±14.18) months. Of them, 4 patients died, 1 patient survived with tumor, and 5 patients survived without tumor. Postoperative metastasis occurred in 5 patients with the mean time of metastasis of (4.40±1.14) months, and local recurrence occurred in 2 patients. The average MSTS score of lower limbs was (26.5± 1.58) three months after surgery. [Conclusion] For this tumor, neoadjuvant chemotherapy is not necessary in some cases, whereas broad boundary surgical resection and chemotherapy might be effective to control it locally. The patients with pathological fractures and insensi- tive chemotherapy are more likely to have recurrence and metastasis after operation, however, the functional recovery of lower limbs is satis- factory after limb salvage therapy.