Background: Chondrosarcoma (CS) is the second most common surgically treated primary malignancy of the bone. The current study explored the effect of the margin and extraosseous tumor component in CS in the femur on local recurrence (LR), LR-free survival (LRFS), and disease-specific survival (DSS). Methods: Among 202 patients, 115 were in the proximal extremity of the femur, 4 in the corpus of the femur, and 83 in the distal extremity of femur; 105 patients had an extraosseous tumor component. Results: In the Kaplan–Meier analysis, factors significant for decreased LRFS were the extraosseous tumor component (p< 0.001), extraosseous tumor component arising from the superior aspect (p< 0.001), histological grade (p= 0.031), and narrow surgical margin < 3 mm (p< 0.001). Factors significantly affecting DSS were the histological grade (p< 0.001), extraosseous component (p< 0.001), LR (p< 0.001), metastases (p< 0.001), and surgical margin (p< 0.001). Conclusions: In CS of the femur, the presence of an extraosseous tumor component has a predictive role in LRFS, and extraosseous tumor component arising from the superior aspect was significant for decreased LRFS. Wide margins were more commonly achieved when the tumor had only an intraosseous component, and the rate of LR was significantly higher in cases with an extraosseous tumor component. When the extraosseous component arose from the superior aspect of the femur, LR occurred more frequently despite achieving adequate margins.
背景：软骨肉瘤是手术治疗中第二常见的原发性骨恶性肿瘤。本研究探讨了股骨软骨肉瘤的手术切缘及骨外肿瘤成分对局部复发、无局部复发生存期及疾病特异性生存期的影响。方法：在202例患者中，115例肿瘤位于股骨近端，4例位于股骨干，83例位于股骨远端；其中105例患者存在骨外肿瘤成分。结果：Kaplan-Meier分析显示，显著降低无局部复发生存期的因素包括：骨外肿瘤成分（p<0.001）、源于股骨上方的骨外肿瘤成分（p<0.001）、组织学分级（p=0.031）以及<3mm的狭窄手术切缘（p<0.001）。显著影响疾病特异性生存期的因素包括：组织学分级（p<0.001）、骨外肿瘤成分（p<0.001）、局部复发（p<0.001）、转移（p<0.001）及手术切缘（p<0.001）。结论：在股骨软骨肉瘤中，骨外肿瘤成分的存在对无局部复发生存期具有预测价值，其中源于股骨上方的骨外肿瘤成分与无局部复发生存期降低显著相关。当肿瘤仅存在骨内成分时更易实现广泛切除，而存在骨外肿瘤成分的病例局部复发率显著更高。即使获得足够手术切缘，当骨外肿瘤成分源于股骨上方时，局部复发的发生频率仍更高。
肿瘤(癌症)患者之家