| ObjectiveBy analyzing the clinical manifestations, hematological examination and X-ray changes of 55 patients of osteosarcoma before and after chemotherapy, to analysis the expression differences of the various index under the new adjuvant chemotherapy in high and low-risk patients.,to discusses and evaluate the clinical characteristic of high-risk osteosarcoma,and find the clinical index which can distinguish the high-risk osteosarcoma, and do more effective chemotherapy and surgery program to improve the patients quality of life accordingly.MethodsRetrospectively reviewed the clinical manifestations, hematological examination and X-ray changes of 55 patients of osteosarcoma under the neoadjuvant chemotherapy in the Orthopeadic Department of Jinan Military General Hospital from December,1999 to December,2006. and Fill out the Registration Form for admission.55 cases of osteosarcoma were followed up for 3 to 10 years,Admission to the first time starting up for 3 years,In the 3 years,25 patients happened to recurrence, metastasis or death,these classified as high-risk group,and 30 patients had no happened to recurrence, metastasis or death which classified as low-risk group.Stat the sex, age location, duration, limb pain, changes before and after chemotherapy, changes in varicose veins before and after chemotherapy, tumor size, X ray type the X-score, before and after chemotherapy,the AKP and LDH level and other indicators.Analyze and summarize the characteristics of these indicators and the changes before and after chemotherapy, and use the statistical methods (chi-square, t test and non-condi-tional Logistic regression analysis)to to analysis the expression differences of the various index under the new adjuvant chemotherapy in high and low-risk patients, to discusses and evaluate the clinical characteristic of high-risk osteosarcoma,and find the clinical index which can distinguish the high-risk osteosarcoma. Results:1. The basic results:55 cases occurred in patients with metastasis, recurrence or death in 25 cases,45%; normal survival in 30 cases, accounting for 55%. Blood tests before and after chemotherapy, no significant change and increase of 9 patients,7 cases of high-risk group, accounting for 77%, low-risk group,2 patients, only 23%.Clinical evaluation of chemotherapy in poor or did not change significantly in 6 patients,5 cases (83.3%) were high-risk patients,1 case (16.7%) were low-risk patients. X-score difference after chemotherapy than before chemotherapy,6 patients were high risk patients. One score= 9 hours after chemotherapy were 28,18 high-risk group accounted for 64.3%, low-risk group of 10, accounting for 35.7%.2.The weight changes:A basic situation:x1 gender, x2 age group, x3 lesions site, x4 course group1, x5 course group 2,x6blood type, x7 chemotherapy;There are 15 male patients In the high-risk group, accounting for 60%,40%are female patients, There are 14 male patients in low-risk group, accounting for 46%,54%are female. Sex has no difference between high and low risk patients (p=0.342).Distal femur, proximal tibia, proximal humerus, and other parts of the proportion of patients in high risk group were 64%,24%,4%,8%.in low risk group, accounting for 47%, 27%,10%,16%, lesions site has no difference between high and low risk patients (p= 0.602).In two different chemotherapy programs (MMIA and DIA) the proportion of high-risk group were 60%and 40%, low-risk group were 83%and 17%, chemotherapy in the high and low risk patients had no difference (p=0.071).X-ray findings of the three types (osteoblasts, hybrid and osteolytic type) the ratio of high-risk group were 36%,52%and 12%, the proportion of low-risk group were 40%,40%, 20%. X-ray type has no difference between high and low risk patients (p=0.533).Each ratio of four different blood types in high-risk patients A B AB O blood types were 20%,32%,20%and 28%;low-risk group were 17%,50%,10%,and 23%.Blood types had no difference, between high and low risk patients, (p=0.511).Divided the age and the duration into two groups bounded by 12 and 3,the results showed that The age and the course of disease has no difference between the high and low risk patients(p=0.498, p=0.514和0.723).2 Clinical manifestations:x8 Changes in pain, x9 skin temperature changes, x10 range of motion changes, x11 changes in limb swelling, x12 changes in varicose veins;All clinical manifestations in the patients, x8 Changes in pain, x9 skin temperature changes, x10 range of motion changes, x11 changes in limb swelling, x12 changes in varicose veins; there were no difference between high and low risk patients,P>0.05.3 X-ray changes:x13X-ray type, x14 after chemotherapy, X-score group (9 for the sector), x15 or without pathological fracture, x16 calcification zone changes, x17 osteolytic zone changes, x18 tumor boundary changes, x19 soft tissue mass size changes, x20 periosteal reaction changes, x21 volume changes, x22 volume before chemotherapy group 150, x23 volume before chemotherapy group 200.X-ray type of osteosarcoma, calcification zone changes, osteolytic zone changes, soft tissue mass size changes and whether occurrence in pathologic fracture in the high and low risk patients there were no difference between them P>0.05,and the periosteal reaction after chemotherapy changes was in the critical value, p= 0.055; tumor volume, volume changes after chemotherapy and the X-score after chemotherapy, were significant differences in the body in the high and low risk patients, P<0.05.4 Hematology changes:x24 the AKP group before chemotherapy 150, x25 the AKP group before chemotherapy 250, x26 the AKP group after chemotherapy 150, x27 the AKP group after chemotherapy 250, x28 the LDH group before chemotherapy 240, x29 the LDH group after chemotherapy 240;After chemotherapy,the AKP has no difference between the high and low risk patients in vivo expression, P<0.05.The sensitivity was more higher when the AKP> 150 than AKP > 250 before chemotherapy (P= 0.002vs P= 0.024), and before chemotherapy the increased LDH was more sensitivity compared with after chemotherapy (P= 0.009vs P= 0.020).3. The numerical variables:(x30 Age, x31 course of disease, x32 tumor volume, x33 X-score before chemotherapy, x34 X-score after chemotherapy, x35-38 AKP and LDH level,before and after chemotherapy, x39 the minimum value of white blood cells after chemotherapy, x40 minimum value of lymphocytes after chemotherapy) The differences of the expression in high and low risk patients.Through the T test in high and low risk group we found the difference between the tumor volume, the lactate dehydrogenase LDH value before and after chemotherapy and the X-score after chemotherapy,P< 0.05.The minimum value of white blood cells after chemotherapy was in a critical value p= 0.048< 0.05. Age, course of disease and AKP levels had no difference before and after chemotherapy in high and low risk patients groups,the P>0.05.4. Non-conditional Logistic regression analysis:Before chemotherapy, the tumor volume≥150cm3, before chemotherapy AKP≥250IU /L,before chemotherapy, LDH≥240IU/L and the lowest white blood cells after chemotherapy, these four indicators of the regression coefficients are positive, The four indicators in the high and low risk patients is proportional to the expression of the body. So we think that when the tumor volume≥150cm3 or AKP≥250IU/L, or LDH≥240IU/L before chemotherapy can be considered as high-risk osteosarcoma.Conclusion1 Gender, age, course, location, blood type, chemotherapy regimen, whether fracture, X ray type, the lowest value after chemotherapy, lymphocytes can not measure the degree of malignancy in patients with osteosarcoma.2. Standard preoperative chemotherapy to osteosarcoma can relief and improve the clinical symptom.We can evaluate the high risk osteosarcoma who was not sensitive to chemotherapy by the clinical manifestations and the X-ray changes before and after chemotherapy. The patients should consider to be a high risk teosarcoma possibility after chemotherapy when the clinical or X-ray manifestation changes gradually increasing After chemotherapy if the clinical and X-ray manifestation changes did not change significantly in the patients,we can not differentiate he was a high-risk or low risk patients.3. After chemotherapy the the minimum value of white blood cells can indirectly reflect the degree of the tumor,the higher the minimum value of white blood cells, the higher the risk. After chemotherapy the patient with no significant decrease in white blood cells should be noted.4. AKP and LDH reflect the activity and the biological behavior of the tumor in different angles.Preoperative chemotherapy can reduce the AKP and LDH level,For high-risk osteosarcoma, the LDH level did not change significantly before and after chemotherapy, and the more higher LDH values than normal, the more greater possibility for the high-risk patients; Wa can not evaluate the degree of malignancy of osteosarcoma. By AKP level After chemotherapy.5. Before Chemotherapy the AKP and the LDH level, tumor volume and the the minimum value of white blood cells is proportional with the prognosis of osteosarcoma. When the AKP≥250IU/L,or LDH≥240IU/L or tumor volume≥150cm3 before chemotherapy can be considered as high-risk osteosarcoma.6. By analyzing the expression differences of the various index in high and low-risk patients.,to discusses the clinical characteristic of high-risk osteosarcoma,and find the high-risk patients,and do more effective chemotherapy and surgery program,is Meaningful for improving the quality of life and Increasing the survival rate. |
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