METHODS: Patient information was downloaded from the SEER (surveillance, epidemiology, and End Results) database from 2004 to 2018. We included all primary pediatric osteosarcoma patients who underwent limb salvage or amputation. Multivariate logistic regression models were used to explore the factors influencing patient choice of amputation. Differences in CSM and other causes of mortality (OSM) between limb salvage and amputation were analyzed using cumulative incidence plots and competitive risk regression tests after 1:1 proportional propensity score matching.
RESULTS: A total of 1,058 pediatric patients with limbs Osteosarcoma were included. Patients who underwent amputations were more likely to be male (OR 1.4, P = 0.024) and more likely to have distant metastasis (OR 2.1, P < 0.001). Before propensity matching, CSM was 1.4 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.017) and 3.4 times higher in OSM (P = 0.007). After adjustment for propensity matching, CSM was 1.5 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.028), but there was no significant difference in OSM (HR 3.2, P = 0.078).
CONCLUSIONS: Our results suggested that amputation is associated with a 1.5-fold increase in CSM in pediatric patients with limbs Osteosarcoma. Therefore, in the surgical selection of pediatric patients with Osteosarcoma, limb salvage surgery should be the first choice in the absence of other contraindications.
方法:从SEER下载患者信息(监测,流行病学,和最终结果)2004年至2018年的数据库。我们纳入了所有接受保肢或截肢的原发性小儿骨肉瘤患者。采用多因素logistic回归模型探讨患者选择截肢的影响因素。在1:1比例倾向评分匹配后,使用累积发生率图和竞争性风险回归测试分析了保肢和截肢之间CSM和其他死亡原因(OSM)的差异。
结果:共纳入1,058例四肢骨肉瘤患儿。接受截肢的患者更可能是男性(OR1.4,P=0.024),更可能发生远处转移(OR2.1,P<0.001)。在倾向匹配之前,截肢患者的CSM比保肢患者高1.4倍(P=0.017),OSM患者的CSM高3.4倍(P=0.007)。在调整倾向匹配后,截肢患者的CSM是截肢患者的1.5倍(P=0.028),OSM差异无统计学意义(HR3.2,P=0.078)。
结论:我们的结果表明截肢与儿童四肢骨肉瘤患者的CSM增加1.5倍相关。因此,在小儿骨肉瘤患者的手术选择中,在没有其他禁忌症的情况下,保肢手术应该是首选。