| Chondrosarcoma is a kind of malignant bone tumor which cells have the trend to differentiate cartilage. It originates from the cartilage tissues. The characteristics of chondrosarcoma is that the tumor cells can produce cartilage tissue, without the formation of bone tissue. It is the second most common primary malignant bone tumor, only next to osteosarcoma. The most common site of chondrosarcoma is pelvis. The main symptoms are swelling and pain alone or exist at the same time, and these will last for a long time. Chondrosarcoma grows up relatively slowly and can extend to the surrounding soft tissue. Distant metastasis is rare, which occurred mainly in the late stage with highly pathological grade. Radiotherapy and chemotherapy is not sensitive to chondrosarcoma, so the surgical operation is the main treatment method. The boundary of the surgical operation depends not only on the grading of tumor, but also on the local conditions of the tumor location, such as the extent of tumor invasion of cortical bone and soft tissue mass.Pelvis, as an important area which connects trunk and lower limbs, contains many important organs, such as the rectum, bladder, uterus, ovary, important neurovascular bundle and so on. The structure of the pelvic ring is complex and pelvic tumor is generally more subtle, so it is difficult to find in the early stage, thus delay treatment. The connections between the pelvis and muscle are mostly non-tendon connections, and the pelvis has rich vascular net but it’s short of natural barrier, so, the Bone tumor of pelvis area often has large soft tissue mass. These above factors have brought great difficulties to the diagnosis and treatment of pelvic Chondrosarcoma. "Pelvic tumor is a major challenge for surgeons", many scholars point out. In recent years, great improvements have been made in the treatment of pelvic chondrosarcoma because of the development of imaging technology as well as the deepen understanding of chondrosarcoma. Most chondrosarcoma patients want to keep the function of limbs under the premise of safety edge. With the pelvic tumor limb salvage operation has become popular, we must consider the integrity and stability of the pelvic ring reconstruction in order to keep the function of limbs. According to the different locations and extents of bone defect after tumor resection, the methods of reconstruction are not same. Overall, pelvic reconstruction surgery is very difficult and may have many postoperative complications, so it’s still a challenging task for orthopedics doctors.ObjectiveExplore the limb functional status in postoperative patients with pelvic chondrosarcoma and the postoperative complications. Investigate the factors influencing the prognosis of pelvic chondrosarcoma patients.MethodsLarge mounts of complete clinical information were from March 2004 to December 2014 at Qilu Hospital of Shandong University. All the 27 cases of patients with the diagnosis of pelvis chondrosarcoma have been pathologically confirmed. The follow-up time was 6-120 months, and the mean follow-up time was 29.3 months. Among the 27 cases,19 cases of them came to our center in their first time, while 8 cases had a relapse after operation in other hospitals. There were 12 males and 15 females. The age of the first time to Qilu hospital of Shandong University is 20-68 years old, the mean age is 47.67 years old. The tumor of 4 cases were located in Ⅰ area,3 cases were located in Ⅰ+Ⅳ area,2 cases were located in Ⅰ+Ⅱ area,1 cases was located in Ⅰ+Ⅱ+Ⅳ area,8 cases were located in Ⅰ+Ⅱ+Ⅲ area, 1 case was located in Ⅰ+Ⅱ+Ⅲ+Ⅳ area,5 cases were located in Ⅱ+Ⅲ area,3 cases were located in Ⅲarea.According to histological grade of ONeal and Ackerman,15 cases were grade Ⅰ,7 cases were grade Ⅱ,5 cases were grade Ⅲ. Two cases were dedifferentiated chondrosarcoma in grade Ⅲ. According to Enneking Surgical Staging System,12 cases were I B stage,10 cases were ⅡB stage,5 cases were ⅢB stage. According to pathological type,15 cases were Conventional chondrosarcoma,1 case was mesenchymal chondrosarcoma,1 case was clear-cell chondrosarcoma,2 cases were dedifferentiated chondrosarcoma,6 cases were myxoid chondrosarcoma.There were 20 patients who accepted operation in our center.5 patients accepted pelvic tumor resection,10 patients accepted Semi-pelvic prosthesis replacement,3 patients accepted pelvic tumor resection inactivation replantation and internal fixation, 2 patients accepted pelvic tumor resection and TSRH internal fixation,1 patient accepted hemipelvectomy.6 patients had radiotherapy.Patient-related factors were analyzed by Kaplan-Meier method, x2 test,Log-rank test and Cox regression model. The MSTS scores was analyzed by ANOVA or t-test.ResultsIn the 27 successful follow-up cases, there were 15 survived and 12 died. The median survival time was 64 months. The survival rate of 1 year was 85.2%, while the survival rate of 3 years was 63.0% and the survival rate of 5 years was 59.3 %.According to the x2 test, whether the patients were dead was related to whether surgical treatment or not, histological grade, and Enneking surgical staging. Kaplan-Meier univariate analysis revealed that the prognosis of pelvic chondrosarcoma was related to whether surgical treatment or not, tumor histological grade and the Enneking surgical staging. Multivariate analysis by Cox regression model suggested that the Enneking surgical staging was the independent prognostic factor. The RR was 2.546.In the 20 surgical patients, there were 5 relapsed cases. The relapse rate was 25%. The disease free survival of 1 year was 95%, while the disease free survival of 3 years was 80% and disease free survival of 5 years was 65.6%. According to the x2 test, whether the pelvic chondrosarcoma relapsed was related to whether there was relapsed cases or not before the surgery. Kaplan-Meier univariate analysis and Multivariate analysis by Cox regression model revealed that the disease free survival was related to whether there was relapsed cases or not before the surgery. The RR was 9.936.The mean of the MSTS socres from the surviving patients after surgery was 24.08±2.96. In the patients’functional Assessment, the Excellent was 53.85%, the Good was 38.46%, the Middle was 7.69%. According to the ANOVA, there were significant differences in different surgical methods by MSTS score.9 patients had postoperative complications.6 patients had suppressed wound healing.1 patient had hemipelvis prosthesis semiluxation,1 patient had phlebothrombosis in the affected limb,1 patient had hemorrhagic shock, pulmonary infection, arrhythmia (Premature Ventricular Beats), hypertensive disease, hypoxic-ischemic encephalopathy.ConclusionFactors affecting the survival rate of patients with pelvic chondrosarcoma and survival time:whether operation treatment, histological grade, Enneking Surgical Staging System. Low histological grade, low Enneking surgical staging could lead to high survival rate. The patients who had been recurrent are more likely to relapse after surgery again.Suitable surgery can be the main treatment, while Radiotherapy can’t improve the prognosis.Wide excision operation is important in the first-time surgery. For tumor involved I or III area, if the continuity of the pelvic ring is not damaged, the patients do not necessarily need to reconstruction operation. While we often do the reconstruction operation when the tumor involved II area.The limb salvage surgical patients have better limb function, especially the patients who had tumorectomy.Postoperative complications included suppressed wound healing, hemipelvis prosthesis semiluxation, phlebothrombosis. Among them the most common complication was suppressed wound healing. |
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