Objective To discuss the treatment and prognosis of multifocal osteosarcoma. Methods Between January 1998 and June 2005, nine patients(seven males and two females), six with synchronous multifocal osteosarcoma and three with metachronous multifocal osteosarcoma were treated in our department. The diagnosis of multifocal osteosarcoma was confirmed by clinical presentation, radiology and pathology. Eight of the nine patients received chemotherapy with adriamycin(60 mg/m2), cisplatinum(100 mg/m2), high-dose methotrexate(8-12 g/m2), vincristine(1.4 mg/m2), ifosfamide(12.5 g/m2), and G-CSF. Based on the response to primary chemotherapy, further chemotherapy plans were made, and different operations were done to control local lesions or to relieve symptoms. Arsenous acid, paclitaxel and VP-16 were used in patients who responded poorly to primary chemotherapy. Results One patient who given up remedy was died in systematic fail due to the cancer after 5 month, five patients who were diagnosed synchronous multifocal osteosarcoma died from progressive disease in 3.5 to 17 months (mean time was 9.8 months). Only two of them had a good response to chemotherapy and had finished at least four cycles of chemotherapy,and they had a better survival time of 15 and 17 months respectively. Three patients with metachronous multifocal osteosarcoma had a better prognosis. After a two-year follow-up, two lived with disease and one lived without disease. Conclusion The prognosis of patients with multifocal osteosarcoma is poor, and patients with metachronous multifocal osteosarcoma have a relatively better prognosis. To improve the prognosis of patients with multifocal osteosarcoma, aggressive chemother-apeutics are needed.

[Objective] To discuss the surgical treatment strategy of spinal hemangioma.[Methods]Data on 33 patients with spinal hemangioma treated from October 1997 to October 2008 were reviewed.There were 19 females and 14 males.The average age was 54 years old.Chief complaints were pain(n=13),myelopathy(n=12),radiculopathy plus local pain(n=8).Nine patients without spinal cord and radial nerve compression underwent percutaneous vertebroplasty(PVP),and 24 patients with spinal cord and radial nerve compression,paravertebral soft tissue mass or spinal unstability were treated by operation.Anterior,anteroposterior and posterior approaches were used in 9,12,and 3 patients respectively.Transarterial embolization was done in 3 patients.[Results]No perioperative complication was observed in 9 patients after PVP,with a mean follow-up of 41 months.Pain was relieved.There was no perioperative death among the 24 patients who received operation.The blood loss during operation was 2739 ml and 1619 ml for anterior and posterior approaches,respectively(P=0.12).One case of paravertebral hematoma,one case of spinal canal hematoma,and one case of wound infection were observed in this group.Pain was relieved in 89%(17/19)of the patients.According to the Frankel Scale,the neurologic situation was improved in all the 12 patients with myelopathy.By a mean follow-up of 48 months,no internal fixation failure was seen.Tumor recurrence or growth was found in 4 patients,two had no symptoms and one underwent radiotherapy for pain.Repeated operation was performed in one patient with myelopathy.[Conclusion]Most patients with symptomatic spinal hemangioma could be treated successfully by surgery.Individual surgical plan should be made according to the reason causing symptoms and the general condition of the patient.

[Objective]To retrospectively study all the low grade central osteosarcoma(LGCO) cases treated in our center in about a past decade.[Method]Thirteen cases with LGCO treated from January 1998 to June 2008 were studied.The mean age at diagnosis was 31-year-old.The anatomical location of the lesions was similar to that of a conventional osteosarcoma.Pain and mass were common complaints with a mean duration of 16 months before diagnosis.Eight cases accepted the first operation in our center,while the other 5 cases had undergone operations in other hospitals with an intralesional resection in four and a marginal resection in one.Eleven patients had an Enneking stage I disease and two had a stage III disease.The first choice for patients with stage I disease was wide resection.[Result]In two patients with local recurrence,the postoperative pathological diagnoses were fibrosarcoma and malignant fibrous histocytoma respectively.The metastatic lesions were found to be a LGCO in both patients with stage III disease.The average follow up duration was 29 months.Lung metastasis occurred in one stage I patient 15 months after operation.Gama-knife was used to get rid of the lung lesions and then systemic chemotherapy was given.Now he was still alive with disease 27 months after the first operation.One of the 2 patients with stage III disease died of the disease 26 months after operation and the other one was failed to follow up 6 months after operation.The other 10 patients were alive without disease at the last follow-up.For those who received limb salvage operations,the mean MSTS 93 score was 79%.[Conclusion]For most patients with LGCO,wide resection of tumor is preferred.Good oncologic and functional results could be expected after a limb salvage operation without chemotherapy.Insufficient resection of tumor would lead to recurrence.Long time follow up is compulsory.High grade sarcomas would be found in some of the local recurrent lesions.Metastasis would occur in few patients and the metastatic lesions may still be a LGCO.

Objective To investigate the expressions and functions of the fusion gene SYT-SSX1 and SYT-SSX2 in synovial sarcoma.Methods The synovial sarcoma tissue samples and clinical data of 22 synovial sarcoma patients were collected.The expressions of fusion genes were detected by RT-PCR.The relationships between fusion gene and clinicopathologic factors were statistically analyzed.The abilities of proliferation,migration and invasion of 3T3 cells transfected with tusion gene plasmids were detected by MTT,migration and invasion assays.Results There were 11 cases with expression of SYT-SSX1 gene and 9 cases with that of SYT-SSX2 genes.The ratio of SYT-SSX1 and SYT-SSX2 was about 1:1.The SYT-SSX1 positive tumors were most biphasic SS and the tumor volumes of patients with SYT-SSX1 positive were larger than that of patients with SYT-SSX2 positive (P =0.028).The SYT-SSX1 positive NIH3T3 cells exhibited higher abilities of proliferation,migration and invasion than SYT-SSX2 positive.Conclusions The ratio of expression of SYT-SSX1 and SYT-SSX2 in synovial sarcoma was about 1∶1.Both SYT-SSX1 and SYT-SSX2 can promote the growth and migration in NIH3T3 cell.The abilities of proliferation and migration of SYT-SS1 were more potent than that of SYT-SSX2.

Objective:To assess the surgical outcome of patients with mesenchymal chondrosarcoma (MCS) treated in our insti-tute. This study was also designed to describe the clinical characteristics, treatment, and outcome of MCS to provide a better understand-ing of its clinical management. Methods:A total of 27 patients with MCS were treated in Peking University People's Hospital, Beijing, China from October 1997 to March 2011. Demographic information and follow-up data were obtained and statistically analyzed. Re-sults:Among the 27 patients, 9 were males and 18 were females with a mean age of 30.4 years (ranging from 14 years to 51 years). The median follow-up time was 42.6 months (ranging from 6 months to 104 months). Among the total number of tumor cases, 22 and 5 were detected in bone tissues and extra-skeletal sites, respectively. A total of 25 patients underwent surgery, but only 17 achieved the standard surgical margin of wide excision. Among these patients, 16 and 13 were subjected to chemotherapy and irradiation. The three-and five-year survival rates were 65%and 49.5%, respectively. Conclusion:MCS is a rare tumor resulting in morbidity with local recur-rences and long-term metastases. In this study, standard multimodal regimens were proposed to treat MCS. The results recommended wide resection with suitable surgical margins as the preferred treatment. However, further studies should be conducted because the infor-mation about the benefits of chemotherapy and radiotherapy for the control of local or systemic symptoms of MCS remains insufficient.

Objective To evaluate effect of en bloc resection of malignant sacral tumor involving partial sacrum and ipsilateral sacroiliac joint with reservation of contralateral sacral foramina.Methods Between February 2005 and July 2010,16 patients with malignant sacral tumor involving partial sacrum and ipsilateral sacroiliac joint underwent hemi-sacrectomy and functional reconstruction.The operation achieved en bloc resection of tumor with reservation of contralateral sacral foramina.There were 10 males and 6 females,aged from 17 to 70 years (average,37.9 years).There were 5 cases of chondrosarcoma,3 cases of Ewing's sarcoma,2 cases of malignant schwannoma,2 cases of osteosarcoma,1 case of malignant giant cell tumor of bone,1 case of lymphoma and 2 cases of metastatic tumor.Results The surgical time ranged from 4 to 11.5 hours (average,6.5 hours).The average blood loss was 3600 ml (range,1500 to 5500 ml).Five patients underwent type Ⅰ resection,while 11 patients underwent type Ⅱ resection.All patients were followed up for 21 to 59 months (average,34.4 months).Three months after operation,13 patients had difficulty with ankle plantar flexion,while sphincter function was more or less reserved in 16 patients.Four patients (25％)had wound healing complications,which was cured after debridement and drainage.Local recurrence occurred in 7 patients.There were 5 cases of local recurrence among 6 patients who had intralesional margin;4 recurrence lesions located in the sacrum and 1 in soft tissue.Eight patients (50.0％) survived without tumor,2 patients (12.5％)survived with tumor,and 6 patients (37.5％) died of tumor.Conclusion The en bloc resection of tumor involving partial sacrum and ipsilateral sacroiliac joint with reservation of contralateral sacral foramina was feasible and had better outcome compared with total sacrectomy.

Objective: To determine the prognostic factors of primary osteosarcoma in adults . Methods:This is a review of 54 patients older than 40 years (24 men and 30 women) who were treated between 1998 and 2011 at the authors ’ institution .Demographic information and follow-up data were obtained and statistically analyzed .Results: Tumors involved the limbs in 30 patients ( 55 .5%) and axial skeleton in 17 patients (31.5%), and arose from soft tissue in 7 patients (13%).And 6 patients (11.1%) had synchronous metastasis .According to our review , tumors were treated surgically in 52 patients (96.3%).Local recurrence was documented in 14 patients (26.9%).Metastasis after diagno-sis appeared in 21 patients (38.9%).In the 52 patients who received the surgical treatment , the 5 year disease-free survival and overall survival rates were 43.7% and 50.4%, respectively.Conclusion:Adult patients with primary osteosarcoma had a poor clinical outcome .Inadequate surgical margins , more tumors in the axial location due to high recurrence rates , metastatic disease at presentation , and large tumor volumes were associated with significantly lower survival rates .Aggressive multi-agent treatment regimens might improve survival .

Objective To explore the recurrence rate, the complications and functional status of 25 patients with grade I chondrosarcoma of long bones treated by intralesional curettage and electrocauterization, and to determine the feasibility and effi?cacy of this method for grade IA chondrosarcoma of long bones. Methods Twenty?five eligible patients treated in our hospital from May 2003 to December 2011, were collected in this study with a mean age of 49 years (range, 28-72 years). According to En?neking staging system, all the lesions were staged as IA. Patients received surgery of the lesion before were excluded. The involved bones were femur (13 patients), tibia (4 patients), and humerus (8 patients). During the operation, a large elliptical cortical window about the size of the longest dimension of the lesion was made to ensure the thorough exposure of the lesion and avoid inadequate curettage. The lesion was curettaged thoroughly after the cortical window was made, then the high speed bur drill was applied to clear away a thin layer of the reactive bone shell. After a thorough lavage of the cavity, electrocauterization was done alongside the cavity wall slowly twice. Allograft or artificial bone was used to fill in the cavity to enhance bone healing. If mechanical property of the long bone was endangered by the cortical window and the surgical procedure, plate and screws were applied to strengthen the bone to avoid post?operative fracture. Results All the 25 patients were followed up regularly. The period of follow?up was from 38 months to 142 months, with a mean time of 80 months. Calcification was observed clearly in all the lesions. The length of the le?sions varied from 4 cm to 11 cm, with an average length of 7 cm. Nineteen patients received a plate and screws fixation because the mechanical property of the affected bone, while the rest received no internal fixation. Deep infection occurred in 1 patient (4%, 1/25) two months after operation. Thorough debridement and packing of bone cement with antibiotics was done to control the infec?tion. The infection has been controlled till the latest follow?up at 62 months after operation. Local recurrence occurred in one pa?tient thirteen months after the primary operation. Tumor resection, mega?prosthesis replacement was applied to the patient. The pa?tient has been disease free till now for 67 months. Mean Musculoskeletal Tumor Society (MSTS) 93 functional score of all patients was 93%(range, 83%-100%). The five?year survival rate of these twenty?five patients was 100%. Conclusion Intralesional cu? rettage together with the application of high?speed bur drill and electrocauterization is an applicable method for grade I chondrosar?coma of long bones. The excellent functional result and low recurrence rate make it a favorable option for the selected cohort of pa?tients.

Objective To explore the relationship between the change in waist circumference (WC) and new onset diabetes (NOD) in a population of north China.Methods A total of 101510 subjects took part in the health examination from 2006 to 2007 for the employees of Kailuan Group.89364 subjects with fasting plasma glucose (FPG) ＜7.0 mmol/L,no history of diabetes,with complete data of FPG and WC,and without taking hypoglycemic agents were sclected as the observation cohort.Subjects who did not participate in the health examination from 2010 to 2011 and had incomplete data were finally excluded and thus 58426 subjects were included for final analysis.According to the baseline WC measurement and its quartile in the health examination during 2006 to 2007,the observed population was divided into two groups (obese group and non-obese group) or four groups ( first,second,third,and forth quartile groups).Multiple logistic regression analysis was used to test the relation between the change in WC and NOD.Results ( 1 ) The incidence of NOD in obese group was higher than that in non-obese group (8.02％ vs 3.37％,P＜0.01 ).Along with increasing WC in the 4 quartile groups,the incidence of NOD was progressively increased,being 2.32％,3.62％,5.46％,and 8.89％ respectively in the total population ( 2.84％,3.65％,5.32％,and 8.95％ in male,and 1.50％,3.41％,6.22％,and 8.51％ in female).( 2 ) Multiple logistic regression analysis showed that compared with the first quartile group,the second,third,and forth quartile groups had increased risks of NOD after adjusting age,gender,and other risk factors,the OR value being 1.17,1.47,and 1.95,respectively.After adjusting above factors in different genders,the influence of the second group on NOD in males and females was not significant,however,they still increased the risks of NOD,with the OR value being 1.08,1.36,and 1.90 in male,and 1.35,1.70,and 1.88 in female,respectively.Conclusion The incidence of NOD is increased with increasing WC.

Objective:To explore the independent prognostic factors of primary osteosarcoma patients under 20 years old after radical surgery, so as to predict the prognosis and survival of patients.Methods:The clinicopathological data of 1 339 patients with primary osteosarcoma diagnosed and registered in the National Cancer Institute Surveillance, epidemiology and outcome database (SEER) from 1984 to 2014 were retrospectively analyzed. Kaplan Meier method was used to calculate the survival rate of patients. Log rank test was used to evaluate the survival difference. Cox multivariate analysis was used to determine the independent prognostic factors of osteosarcoma after radical surgery factor.Results:The results of primary osteosarcoma patients undergoing radical surgery found that 34 cases (2.54%) aged 0-5 years old, 236 cases (17.63%) aged 6-10 years old, and 600 cases (44.81%) aged 11-15 years old and 469 cases (35.02%) aged 16-20 years old. The median survival time was 68 months. Among them, 757(56.53%) were male and 582(43.47%) were female. Among the 1 339 cases, 986 were white (73.64%), followed by black 230(17.18%), and 123 other races (9.18%). Multivariate analysis revealed that males ( HR=1.242; 95% CI:1.024-1.505), axial osteosarcoma ( HR=1.589; 95% CI:1.179-2.166), and regional invasion of osteosarcoma ( HR=1.470; 95% CI:1.156-1.870), distant metastasis ( HR=3.536; 95% CI:2.725-4.589) were independent risk factors for overall survival. Other types of osteosarcoma ( HR=0.471; 95% CI:0.285-0.779) were independent protective factors for overall survival. Conclusions:Based on the SEER database, this study identified independent prognostic factors for patients with primary osteosarcoma under the age of 20 who underwent radical surgery, which will help clinicians formulate individualized medical strategies and predict patients′ prognosis.