病理性骨折作为软骨肉瘤的不良预后因素：系统综述、荟萃分析和机构病例系列的结果

IF 3.5 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2026-02-01 Epub Date: 2025-12-06 DOI:10.1016/j.jbo.2025.100735

Julian P. Maier , Ida Peiss , Felix Klingler , Nikos Karvouniaris , Kilian Reising , Hagen Schmal , Georg W. Herget

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引用次数: 0

摘要

病理性骨折被认为是原发性骨肉瘤潜在的不良预后因素。虽然一些研究表明更高的复发率和降低的生存率，但软骨肉瘤（CS）特异性的可靠数据仍然有限。本研究评估了CS患者病理性骨折（PF）与预后的相关性。方法根据PRISMA指南进行系统评价和meta分析。符合条件的研究包括骨CS患者，并根据骨折状态和肿瘤预后进行比较。对研究设计、质量和终点进行了评估，并进行了汇总荟萃分析。此外，回顾性分析了来自机构队列的临床数据。结果9项研究共纳入1185例患者和245例PF，符合纳入标准。荟萃分析显示，PF状态与1-5年的不良生存率显著相关（合并OR 0.40; 95% CI 0.26-0.62; p < 0.0001）。去分化CS的死亡风险增加尤为明显（总危险度1.96;95% CI 1.46-2.63; p < 0.00001）。机构数据支持这些发现，尽管受样本量限制，但PF与较差的总生存期（HR 3.90; 95% CI 0.69-21.98; p = 0.12）和无进展生存期（HR 3.17; 95% CI 0.58-17.36; p = 0.18）相关。结论病理性骨折对软骨肉瘤的预后有明显的不良影响，特别是在高级别和去分化亚型以及前5年的随访中。我们的机构数据证实了meta分析的结果。这些结果强调了个性化手术管理和强化预后监测对伴有PF的CS患者的重要性。

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$Pathological fractures as an adverse prognostic factor in chondrosarcoma: Results of a systematic review, meta-analysis and institutional case series$

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Pathological fractures as an adverse prognostic factor in chondrosarcoma: Results of a systematic review, meta-analysis and institutional case series

Background

Pathological fractures are recognized as a potential, adverse prognostic factor in primary bone sarcomas. While some studies suggest higher recurrence rates and reduced survival, robust data specific to chondrosarcoma (CS) remain limited. This study evaluates the prognostic relevance of pathological fractures (PF) in CS patients.

Methods

A systematic review and meta-analysis were conducted according to PRISMA guidelines. Eligible studies included patients with CS of the bone, with comparative groups based on fracture status and oncological outcomes. Study design, quality, and endpoints were assessed, and pooled meta-analysis was conducted. Additionally, clinical data from an institutional cohort was analyzed retrospectively.

Results

Nine studies, with a total of 1,185 patients and 245 PF cases, met the inclusion criteria. Meta-analysis revealed that PF status was significantly associated with inferior survival at 1–5 years (pooled OR 0.40; 95 % CI 0.26–0.62; p < 0.0001). The increased risk of death was particularly evident in dedifferentiated CS (pooled HR 1.96; 95 % CI 1.46–2.63; p < 0.00001). Institutional data supported these findings, that PF was associated with worse overall survival (HR 3.90; 95 % CI 0.69–21.98; p = 0.12) and progression-free survival (HR 3.17; 95 % CI 0.58–17.36; p = 0.18), although significance was limited by sample size.

Conclusions

Pathological fractures entail a significantly adverse prognosis in chondrosarcoma, particularly in high-grade and dedifferentiated subtypes and within the first 5 years of follow-up. Our institutional data corroborates meta-analysis findings. These results underscore the importance of personalized surgical management and intensive outcome monitoring for CS patients presenting with PF.

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来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.