JCO：不同骨肉瘤患者群体化疗结局存在差异

为考察性别、年龄及毒性与骨肉瘤患者生存间的关系，LIVESTRONG青年联盟根据骨肉瘤新辅助化疗相关前瞻性研究以及注册信息，对患者数据进行了一项荟萃分析。该分析结果发表于2013年5月13日在线出版的《临床肿瘤学杂志》(Journal of Clinical Oncology)上。研究人员通过对PubMed已发表文献进行鉴定得到合格数据集。最终的合并数据集包括来自5个国际合作团体的4,838 例患者。

经过对研究起始阶段的重要变量如肿瘤部位及组织类型进行分析后发现，女性患者的总生存率高于男性(P = .005)，儿童患者结局好于青少年及成人患者(P = .002)。术后多变量界标性分析表明，化疗诱导后的较高肿瘤坏死率与较长的生存时间有关 (P < .001)，同样有关的因素还有女性患者(P = .004)及3级或4级黏膜炎(P = .03)。在该界标性分析中，年龄组别并非统计学意义上的显著因素(P = .12)。根据报告，女性患者在3级或4级血小板减少发病率方面相对高于男性患者(P < .001)。而在3级或4及中性粒细胞减少及血小板减少方面，儿童患者报告发病率最高(二者P < .001)。在取得较佳肿瘤坏死结局方面，女性患者高于男性患者(P = .002)，儿童患者高于成人患者(P < .001)。

上述结果表明，在男女性患者间及儿童成人患者间，化疗方式存在本质差别。在化疗对患者总体结局产生关键影响的情况下，这些差异可对患者最终生存产生影响。

Benefits and Adverse Events in Younger Versus Older Patients Receiving Neoadjuvant Chemotherapy for Osteosarcoma: Findings From a Meta-Analysis.
Abstract
PURPOSEThe LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival. PATIENTS AND METHODSSuitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups.ResultsAfter accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001). CONCLUSIONThese results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes.