中文摘要：

目的：比较合并病理性骨折与未合并病理性骨折肢体骨肉瘤患者的临床特征,并探讨影响预后的相关因素。方法：回顾性分析2003年10月—2011年10月确诊为肢体骨肉瘤的244例患者的病历资料,根据是否合并病理性骨折分为合并病理性骨折与未合并病理性骨折两组,比较这两组患者临床特征的差异。应用Kaplan-Meier法进行生存分析,应用log-rank检验进行病理性骨折组预后的单因素分析,应用COX比例风险回归模型进行预后的多因素分析。结果：与未合并病理性骨折相比,合并病理性骨折的肢体骨肉瘤患者的肿瘤体积较大（P=0.012）,上肢骨肉瘤（P=0.004）以及接受截肢手术的患者所占比例较高（P=0.032）,且易出现局部复发（P=0.002）。病理性骨折组的中位生存时间为16个月,未合并病理性骨折组的中位生存时间为21个月（P=0.006）。单因素分析显示,肿瘤大小、Enneking外科分期、Karnofsky体能状况评分、术后辅助化疗次数、局部复发和远处转移是影响病理性骨折患者预后的相关因素（P〈0.05）。多因素分析显示,Karnofsky体能状况评分、术后辅助化疗次数和远处转移是影响预后的独立相关因素。结论：合并病理性骨折的肢体骨肉瘤患者与未合并病理性骨折的患者相比,肿瘤体积较大,上肢骨肉瘤以及接受截肢手术的比例较高,易出现局部复发,且预后较差。KPS评分、术后辅助化疗次数和远处转移是影响合并病理性骨折的肢体骨肉瘤患者预后的独立因素。

英文摘要：

Objective： To identify the clinical features and prognostic factors in relation to extremity osteosarcoma with pathological fracture. Methods： The clinical data from 244 patients with extremity osteosarcoma between October 2003 and October 2011 were retrospectively reviewed. These patients were divided into two groups： patients with pathological fracture group and the patients without pathological fracture group. The differences in the clinical features of the two groups were analyzed. The survival analysis was performed using Kaplan-Meier method. For patients with pathological fracture, a univariate analysis （log-rank） was used to determine the prognostic factors related to the survival, and a COX proportional hazards regression model was used to identify the independent prognostic factors. Results： A higher proportion of patients with larger tumor size （P = 0.012）, humeral osteosarcoma （P = 0.004） or local recurrence （P = 0.002） was observed in patients with pathological fracture. Additionally, more patients with pathological fracture received an amputation surgery, as compared with patients without pathological fracture （P = 0.032）. The median survival time of patients with pathological fracture was significantly shorter than that of patients without pathological fracture （16 vs 21 months, P = 0.006）. The univariate analysis showed that the significant prognosis-related factors were the tumor size, Enneking’s surgical staging, KPS （Karnofsky performance status） score, cycles of adjuvant chemotherapy, local recurrence and metastasis （P 0.05）. The multivariate analysis revealed that the factors of KPS score, cycles of adjuvant chemotherapy and metastasis were the independent prognostic factors of extremity osteosarcoma with pathological fracture. Conclusion： Compared with the patients without pathological fracture, a higher proportion of patients receiving amputation surgery or having larger tumor size, humeral osteosarcoma or local recurrence was observed in patients