초록
목적: 본 연구는 수술 전 항암 약물 치료가 전이가 없는 골육종 환자의 생존율과 전이에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 1984년부터 2010년까지 사지에 발생한, 전이가 없는 원발성 골육종으로 수술적 절제술과 수술 후 항암 약물 치료를 시행한 30세 미만의 환자 225명을 후향적으로 분석하였다. 평균 연령은 14.4세, 평균 추시기간은 9.1년이었다. 수술 후에만 항암 약물 치료를 시행한 군과 수술 전, 후 약물 치료를 시행했던 두군의 임상적 특성과 생존율을 비교하였다. 결과: 전체 225예 중 수술 후 약물 치료 군은 32예, 수술 전후 약물 치료 군은 193예였다. 수술 후 약물 치료 군은 절단 수술과(p<0.001), 전이의 빈도가 유의하게(p=0.004) 높았으며, 전이 발생시기도 빨랐다. 수술 후 약물 치료 군에서는 5년 생존율 51%로 수술 전후 약물 치료 군의 84%보다 낮았다(p=0.001). 국소재발은 유의한 차이가 없었다. 결론: 사지에 발생한 골육종 환자에서 수술 전 항암 약물 치료는 전이의 억제와 생존율 향상에 도움이 된다.
Purpose: Multidisciplinary approaches of surgical resection and chemotherapy have been widely used for the treatment of non-metastatic osteosarcomas. We aimed to assess the effect of neoadjuvant chemotherapy for metastasis and disease-specific survival. Materials and Methods: Authors retrospectively reviewed 225 young (<30 years old) and non-metastatic osteosarcoma patients who underwent surgical resection and postoperative chemotherapy between February 1984 and July 2010. Mean age was 14.4 years old (ranged: 4-29 years old) and average follow-up period was 9.1 years (2-28 years). The patients were divided into two groups according to the application of preoperative chemotherapy. Both groups were compared with clinical characteristics, metastasis-free survival and disease-specific survival. Results: All of 225 patients, 32 patients were treated with postoperative chemotherapy and 193 patients were performed preoperative and postoperative chemotherapy. Postoperative chemotherapy group showed significantly high rate of amputation (p<0.001). Metastasis was occurred in 101 patients. Postoperative chemotherapy group indicated significant higher rate of metastasis (69% vs 41%, p=0.004) and early development of metastasis (mean: 11.5 vs 20.3 months, p=0.045) than pre-and postoperative chemotherapy group. Fifty-seven patients were died of osteosarcoma. Postoperative chemotherapy group revealed significant lower rate of 5-year disease-specific survival than pre-and postoperative chemotherapy group (51% vs 84%, p=0.001). Adult (>15 years) and large sized tumor (>8 cm) were meaningful risk factors of metastasis and disease-specific survival. Although, local recurrences were occurred in 13 patients, there was no significant difference. Conclusion: Neoadjuvant chemotherapy offers better disease-specific survival and metastasis-free survival.