X线检查发现病理性骨折对骨肉瘤预后的影响分析

目的:通过荟萃分析研究骨肉瘤患者局部复发率、截肢率、外科手术边界范围和新辅助化疗敏感性与发生病理性骨折之间有无相关性，为临床评估骨肉瘤患者的预后提供依据。方法:计算机检索Pub Med、Cochrane、EMBASE and the Web of Knowledge数据库英文文献，检索年限均为建库至2016年10月15日，辅以其他检索方式，收集探索病理性骨折与骨肉瘤患者预后指标之间相关性的临床研究。由两名研究者进行筛选、评价质量及提取资料，并用Review manager 5.2软件进行荟萃分析、发表偏倚分析等统计分析。结果:共纳入成人相关研究5篇，总计1 502人，荟萃分析结果显示高复发率和高截肢率与发生病理性骨折有关（复发率:n=1 018；OR=1.83；95%CI:1.06~3.15；P=0.03；截肢率:n=1 502；OR=1.84；95%CI:1.25~2.72；P=0.002），而并未发现外科手术边界和化疗敏感性与发生病理性骨折有关（外科边界:n=1 501；OR=0.74；95%CI:0.39~1.40；P=0.35；敏感性:n=1 420；OR=1.41；95%CI:0.98~2.05；P=0.07）。根据异质性分析结果选用随机或非随机化模型。结论:骨肉瘤患者中X线检查发现病理性骨折预示高复发率和截肢率，预示预后不良，但并不影响化疗的敏感性和获得满意的手术切除范围。 

Pathologic Fracture Predicts for Poor Prognosis in Osteosarcoma for Recurrence and Amputation Based on X-ray

Objective:The significance of pathologic fracture and prognosis for osteosarcoma is still controversial. The aim was to provide a Meta-analysis for pathologic fracture and prognostic features of osteosarcoma patients. Methods:A detailed search was made in MEDLINE, EMBASE and the Web of Knowledge for relevant original articles published in English; methodological quality of the included studies was also assessed. Two reviewers extracted data independently. Studies were pooled and odds ratio (ORs) with corresponding confidence intervals (CIs) were calculated. Results:Pool analysis of 1502 patients from 5 eligible studies was performed. Combined OR of pathologic fracture indicated that pathologic fracture was associated with local recurrence (n=1018 in 4 studies;OR=1.83;95％CI:1.06～3.15;P=0.03) and the limb salvage (n=1502 in 5 studies;OR=1.84;95％CI:1.25～2.72;P=0.002) but not with adequate margin (n=1501 in 5 studies;OR=0.74;95％CI:0.39～1.40;P=0.35) or histological response to neoadjuvant chemotherapy (n=1420 in 4 studies; OR=0.41; 95％ CI:0.98～2.05;P=0.07). Conclusion:The results of this Meta-analysis indicate that a higher risk of local recurrence and amputation were achieved in osteosarcoma patients with pathological fracture than those without pathological fracture. The pathologic fracture is a predictor of poor prognosis in osteosarcoma.