• 1. 新疆醫(yī)科大學(xué)附屬腫瘤醫(yī)院（烏魯木齊 830054） 2. 新疆建工醫(yī)院（烏魯木齊 830002） 3. 四川大學(xué)華西醫(yī)院中國循證醫(yī)學(xué)中心/國際臨床流行病學(xué)網(wǎng)華西研究與培訓(xùn)中心（成都 610041）;

目的 　評(píng)價(jià)大劑量化療治療原發(fā)性高分化骨肉瘤的療效是否優(yōu)于標(biāo)準(zhǔn)劑量化療。
方法　 采用Cochrane系統(tǒng)評(píng)價(jià)方法，檢索MEDLINE、Embase、OVID、Cochrane圖書館臨床對(duì)照試驗(yàn)數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻(xiàn)光盤數(shù)據(jù)庫，以及手工檢索《中華腫瘤雜志》、《中國腫瘤臨床》、《腫瘤》等（檢索時(shí)間為自創(chuàng)刊至2006年2月）。由兩名評(píng)價(jià)者共同評(píng)價(jià)納入研究質(zhì)量，對(duì)同質(zhì)研究進(jìn)行Meta分析。
結(jié)果　 共納入4個(gè)研究、937例原發(fā)性、非轉(zhuǎn)移性、高分化肢體骨肉瘤患者。所有研究均未描述具體的隨機(jī)方法、是否盲法，只有1個(gè)研究描述分配隱藏，所有研究均報(bào)告了失訪及退出原因以及基線資料。大劑量化療組在5年無瘤生存率 [RR 1.10, 95%CI (0.96, 1.25)] 、5年總生存率 [RR 1.08, 95%CI (0.97, 1.20)]、局部復(fù)發(fā)率 [RR 0.92, 95%CI (0.54, 1.57)]、組織學(xué)反應(yīng)良好者所占的比例 [RR 0.93, 95%CI (0.81, 1.07)]、 保肢率 [RR 0.97, 95%CI (0.92, 1.02)] 方面與低劑量組相比差異無統(tǒng)計(jì)學(xué)意義；腫瘤對(duì)術(shù)前化療組織學(xué)反應(yīng)良好與不良的5年無瘤生存率差異有統(tǒng)計(jì)學(xué)意義。
結(jié)論 　現(xiàn)有研究結(jié)果顯示，腫瘤對(duì)術(shù)前化療的組織學(xué)反應(yīng)是骨肉瘤的一個(gè)獨(dú)立的預(yù)后因素。大劑量化療治療原發(fā)性高分化骨肉瘤不優(yōu)于低劑量化療，但由于納入研究存在選擇性偏倚、實(shí)施偏倚、以及發(fā)表偏倚的中度可能性，很可能影響結(jié)果的可靠性，期望將來高質(zhì)量的隨機(jī)對(duì)照試驗(yàn)提供更可靠的證據(jù)。

引用本文： 李同相,白靖平,錫林寶勒日,江仁兵,何祖勝,黃衛(wèi)民,吳泰相. 大劑量化療與標(biāo)準(zhǔn)劑量化療治療原發(fā)性高分化骨肉瘤療效的系統(tǒng)評(píng)價(jià). 中國循證醫(yī)學(xué)雜志, 2006, 06(11): 826-832. doi: 復(fù)制

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2. Xu WP, Feng CH. Orthopaedic Oncology. First Edition. Beijing: Peoples Military Medical Publisher; 2001. 179.
3. Horfman HD, Czerniak B. Bone tumors. St Louis: Mosby; 1998: 32–33.
4. Saeter G, Oliveira J, Bergh J, ESMO Guidelines Task Force. ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of osteosarcoma. Ann Oncol, 2005; 16 (Suppl 1): 73–74.
5. Dahlin D, Coventry M. Osteogenic sarcoma: a study of six hundred cases. J Bone Joint Surg Am, 1975; 57(3): 397–404.
6. Enneking WF. An abbreviated history of orthopaedic oncology in North America. Clin Orthop Relat Res, 2000; (374): 115–124.
7. Goorin AM, Abelson HT, Frei III E. Osteosarcoma: Fifteen years later. N Engl J Med, 1985; 313(26): 1637–1642.
8. Campanacci M, Bacci G, Bertoni F, et al. The treatment of osteosarcoma of the extremities: twenty years’ experience at theIstituto Ortopedico Rizzoli. Cancer, 1981; 48(7): 1569–1581.
9. Hudson M, Jaffe MR, Jaffe N, et al. Pediatric osteosarcoma: therapeutic strategies, results and alprognostic factors derived from a 10-year experience. J Clin Oncol, 1990; 8(12): 1988–1997.
10. Jaffe N. Adjuvant chemotherapy in osteogenic sarcoma. J Clin Oncol, 1984; 2(10): 1179–1181.
11. Meyers PA, Heller G, Healey J, et al. Chemotherapy for non-metastatic osteosarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol, 1992; 10(1): 5–15.
12. Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomised prospective trial. J Clin Oncol, 1987; 5(1): 21–26.
13. Bacci G, Avella M, Capanna R, et al. Neoadjuvant chemotherapy in the treatment of osteosarcoma of the extremities: preliminary results in 131 cases treated preoperatively with methotrexate and cisdiamminoplatinum. Italian Journal of Orthopaedics & Traumatology, 1988; 14(1): 23–39.
14. Gaetano B, Cristiana F, Stefano F, et al. Neoadjuvant chemotherapy forosteosarcoma of the extremity: intensification of preoperative treatment does not increase the rate of good histologic response to the primary tumor or improve the final outcome. J Pediatr Hematal Onco, 2003; 25(11): 845–853.
15. Meyers PA, Gorlick R, Hellr G, et al. Intensification of preoperative chemotherapy for osteogenic sarcoma:rsults of the memorial sloan-kettering (t12) protocol. Journal of Clinical Oncology, 1998; 16(7): 2452–2458.
16. Bacci G, Gherlinzoni F, Picci P, et al. Adriamycin-methotrexae high dose as verss adriamycin-methotrexae moderate dose as adjuvant chemotherapy for osteosarcoma of the extremities: a randomized study. Eur J Clin Oncol, 1986; 22(11): 1337–1345.
17. Souhami L, Craft AW, Van der Eijken JW, et al. Randomized trial of two regmens of chemotherapy in operative osteosarcoma: a study of the European osteosarcoma intergroup. Lancet, 1997; 350(9082): 911–917.
18. Damron TA, Pritchard DJ. Current combined treatment high-grade osteosarcomas. Oncology, 1995; 9(4): 327–343; discussion 343–344, 347–350.
19. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am, 1997; 44(3): 973–989.
20. Rosen G, Marcove RC, Caparros B, et al. Primary osteogenic sarcoma:the rational for preoperative chemotherapy and delayed surgery. Cancer, 1979; 43(6): 2163–2177.
  1. 1. 徐萬鵬, 馮傳漢. 主編. 骨科腫瘤學(xué). 第1版. 北京: 民軍醫(yī)出版社; 2001. 179.
  2. 2. Xu WP, Feng CH. Orthopaedic Oncology. First Edition. Beijing: Peoples Military Medical Publisher; 2001. 179.
  3. 3. Horfman HD, Czerniak B. Bone tumors. St Louis: Mosby; 1998: 32–33.
  4. 4. Saeter G, Oliveira J, Bergh J, ESMO Guidelines Task Force. ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of osteosarcoma. Ann Oncol, 2005; 16 (Suppl 1): 73–74.
  5. 5. Dahlin D, Coventry M. Osteogenic sarcoma: a study of six hundred cases. J Bone Joint Surg Am, 1975; 57(3): 397–404.
  6. 6. Enneking WF. An abbreviated history of orthopaedic oncology in North America. Clin Orthop Relat Res, 2000; (374): 115–124.
  7. 7. Goorin AM, Abelson HT, Frei III E. Osteosarcoma: Fifteen years later. N Engl J Med, 1985; 313(26): 1637–1642.
  8. 8. Campanacci M, Bacci G, Bertoni F, et al. The treatment of osteosarcoma of the extremities: twenty years’ experience at theIstituto Ortopedico Rizzoli. Cancer, 1981; 48(7): 1569–1581.
  9. 9. Hudson M, Jaffe MR, Jaffe N, et al. Pediatric osteosarcoma: therapeutic strategies, results and alprognostic factors derived from a 10-year experience. J Clin Oncol, 1990; 8(12): 1988–1997.
  10. 10. Jaffe N. Adjuvant chemotherapy in osteogenic sarcoma. J Clin Oncol, 1984; 2(10): 1179–1181.
  11. 11. Meyers PA, Heller G, Healey J, et al. Chemotherapy for non-metastatic osteosarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol, 1992; 10(1): 5–15.
  12. 12. Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomised prospective trial. J Clin Oncol, 1987; 5(1): 21–26.
  13. 13. Bacci G, Avella M, Capanna R, et al. Neoadjuvant chemotherapy in the treatment of osteosarcoma of the extremities: preliminary results in 131 cases treated preoperatively with methotrexate and cisdiamminoplatinum. Italian Journal of Orthopaedics & Traumatology, 1988; 14(1): 23–39.
  14. 14. Gaetano B, Cristiana F, Stefano F, et al. Neoadjuvant chemotherapy forosteosarcoma of the extremity: intensification of preoperative treatment does not increase the rate of good histologic response to the primary tumor or improve the final outcome. J Pediatr Hematal Onco, 2003; 25(11): 845–853.
  15. 15. Meyers PA, Gorlick R, Hellr G, et al. Intensification of preoperative chemotherapy for osteogenic sarcoma:rsults of the memorial sloan-kettering (t12) protocol. Journal of Clinical Oncology, 1998; 16(7): 2452–2458.
  16. 16. Bacci G, Gherlinzoni F, Picci P, et al. Adriamycin-methotrexae high dose as verss adriamycin-methotrexae moderate dose as adjuvant chemotherapy for osteosarcoma of the extremities: a randomized study. Eur J Clin Oncol, 1986; 22(11): 1337–1345.
  17. 17. Souhami L, Craft AW, Van der Eijken JW, et al. Randomized trial of two regmens of chemotherapy in operative osteosarcoma: a study of the European osteosarcoma intergroup. Lancet, 1997; 350(9082): 911–917.
  18. 18. Damron TA, Pritchard DJ. Current combined treatment high-grade osteosarcomas. Oncology, 1995; 9(4): 327–343; discussion 343–344, 347–350.
  19. 19. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am, 1997; 44(3): 973–989.
  20. 20. Rosen G, Marcove RC, Caparros B, et al. Primary osteogenic sarcoma:the rational for preoperative chemotherapy and delayed surgery. Cancer, 1979; 43(6): 2163–2177.