Short-term Clinical Effect Of Evaluation On The Neo-adjuvant Chemotherapyof Osteosarcoma In Extremities

Objective To explore the short-term clinical effects of the efficacy evaluation system of neo-adjuvant chemotherapy for osteosarcoma.Methods A retrospective analysis of 2013 January to 2013 December in our department were to evaluate the effect of neo-adjuvant chemotherapy with complete follow-up data of 36 patients with osteosarcoma of the extremities. For patients diagnosed with osteosarcoma after neo-adjuvant chemotherapy, after chemotherapy were scored using neo-adjuvant chemotherapy in our department assessment system is designed, according to the judgment of the effect of neoa-djuvant chemotherapy scoring results. Chemotherapy after surgery, the tumor specimens were taken for analysis and calculation of the tumor necrosis rate. Postoperative adjuvant chemotherapy for 4-6 cycles, and follow-up. According to the above data, statistical analysis was carried out using different statistical methods, were observed the clinical effect in the near future to the neo-adjuvant chemotherapy evaluation system.Results A total of 36 patients were enrolled in this study. The patients were followed up for 13-27 months, average 20.5 months. Among them, male 23 cases, female 13 cases, male to female ratio is about 1.8:1, the average age of onset was 18 years old; distal femur are the most common sites, followed by proximal tibia and proximal humerus, the ratio is about 3.75:2.5:1; according to the Enneking criteria, 3 cases of IIA patients(8.3%), 26 cases of stage IIB patients(72.2%), 7 cases of III patients(19.4%); the neoadjuvant chemotherapy effect score more than 30 points(both chemotherapy effect) of 22 people(61.1%), poor curative effect of 14 people(38.9%); 28 cases of operation mode in limb salvage treatment of patients with 8 cases, amputation, and the limb salvage rate was 77.8%; postoperative specimen and calculate the tumor necrosis rate after chemotherapy, the tumor necrosis rate of more than 90% of 12 cases(33.3%), 24 cases of <90%(66.7%). Using Fisher’s exact test, the comparison of the tumor local recurrence and distant metastasis, the different modes of operation(P = 1), neoadjuvant chemotherapy score(P = 0.683) and the level of tumor necrosis rate(P = 0.224) there were no significant differences in local recurrence in the different operation mode(; P = 0.422) on tumor metastasis and no significant difference, while the score more than 30 points of new adjuvant chemotherapy in patients with distant metastasis rate than the score of less than 30 of patients had a decreasing trend(P = 0.011). At the same time, tumor necrosis rate was higher than 90% after chemotherapy in patients with distant metastasis rate is less than 90% of patients had a decreasing trend(P = 0.025). According to the results of logistic regression OR = 1.318, CI =(1.067, 1.629), P = 0.011, the linear correlation of the results with r = 0.548, P = 0.001 showed that neoadjuvant chemotherapy score and tumor necrosis rate was positively correlated, that is the higher the score, the better the effect of chemotherapy. Influence factors on the score of the construction of generalized multivariate linear model, the only tumor stage of scale effect. New adjuvant chemotherapy was t test of operation mode, local recurrence and distant metastasis of operation mode, score(t = 3.34, P = 0.002) and distant metastasis(t = 3.72, P = 0.001) to make predictions, and make a good prediction of local tumor recurrence or not(t = 1.43, P = 0.162).Conclusion Neo-adjuvant chemotherapy effect evaluation system has certain advantages to judge the effect of chemotherapy in patients with osteosarcoma, through to score after chemotherapy in patients with clinical and laboratory examination and imaging examination, the effect of chemotherapy and can be quantified, grading and tumor necrosis rate was positively correlated. By preoperative score can be a good judge of osteosarcoma with neo-adjuvant chemotherapy effect, and the operation mode and the metastasis of some pre judgment, has certain clinical application value and promotion value. But it is lack of the statistical analysis of each evaluation index weight, it is still needed to be further perfected and improved.