Disease and laboratory characteristics.

Background
Pre-diagnosis manipulative therapies in patients diagnosed with osteosarcoma can compromise patients’ outcomes. Limited literature exists on the pre-diagnosis non-oncological management of osteosarcoma, especially in resource-limited settings. We described and characterized the practice of pre-diagnosis manipulative therapy at the reference cancer treatment center in Uganda as a first step to improving the quality along the osteosarcoma treatment pathway.
Methods
We reviewed the demographic and clinical characteristics, pre-referral management, and outcome of children under 18 years treated for osteosarcoma at the Uganda Cancer Institute between January 2016 and December 2020. Data on pre-diagnosis management were extracted, as well as clinical and disease characteristics and outcome. Descriptive statistics and Kaplan-Meier survival analysis were used.
Results
Nineteen (25.7%) of the 74 children with osteosarcoma in the current study had undergone prior manipulative therapy. The main forms of manipulative therapy were local therapeutic cuttings with the application of local herbs in 6 (31.5%) patients, massaging in 5 (26.3%), attempted incision and drainage in 4 (21.1%), and treatment as a local infection (osteomyelitis or arthritis) in 4 (21.2%). The majority, 15 (78.9%), of the patients who had manipulative therapy were males (X² = 5.73; p = 0.031). Children who underwent manipulative therapy were referred after a median of 45 days (range 11–139) compared to their counterparts, who were referred after a median of 28 days (range 1–147) (p = 0.012). Patients with manipulative therapy had a metastatic rate of 77.8%, while the rate was 60.4% for those who did not have manipulative therapy. The serum lactate dehydrogenase level was higher in patients who had manipulative therapy compared to those who did not have manipulative therapy (X2 = 3.98; p = 0.046). The median survival was 1.0 year (95% CI 0.8–1.3) for patients who underwent prior manipulative therapy and 1.8 years (95% CI 1.4–2.2) for those who did not report any form of manipulative therapy (p = 0.961).
Conclusion
Pre-diagnosis manipulative therapies lead to poorer outcomes in patients diagnosed with osteosarcoma, underscoring the need for bridging the quality gap in the osteosarcoma treatment pathway. This should include sensitization of the community and healthcare provider’s, strengthening patient referral pathways, and improved accessibility to cancer treatment centers.

研究背景
确诊为骨肉瘤（osteosarcoma）的患者在确诊前接受的侵入性操作治疗，可能会损害其预后结局。目前关于骨肉瘤确诊前非肿瘤相关治疗的相关文献较为匮乏，在资源有限的医疗环境中尤其如此。本研究以乌干达定点癌症治疗中心内的确诊前侵入性操作治疗实践为研究对象，对其进行描述与特征分析，以此作为优化骨肉瘤诊疗全流程质量的第一步举措。

研究方法
本研究回顾性分析了2016年1月至2020年12月期间，乌干达癌症研究所收治的74例18岁以下骨肉瘤患儿的人口统计学与临床特征、转诊前诊疗方案及预后结局。研究提取了患儿确诊前的治疗相关数据，以及临床、疾病特征与预后结局数据，并采用描述性统计方法与Kaplan-Meier生存分析进行数据分析。

研究结果
本研究纳入的74例骨肉瘤患儿中，有19例（25.7%）在确诊前接受过侵入性操作治疗。此类治疗的主要形式包括：局部切开清创并外敷本地草药的治疗方式，共6例（31.5%）；按摩疗法5例（26.3%）；尝试切开引流术4例（21.1%）；以及按局部感染（骨髓炎或关节炎）进行治疗4例（21.2%）。接受侵入性操作治疗的患儿中，绝大多数为男性，共15例（78.9%）（χ²=5.73，P=0.031）。接受侵入性操作治疗的患儿中位转诊时间为45天（范围11~139天），而未接受该治疗的患儿中位转诊时间为28天（范围1~147天），两组差异具有统计学意义（P=0.012）。接受侵入性操作治疗的患儿肿瘤转移率为77.8%，未接受该治疗的患儿转移率为60.4%。接受侵入性操作治疗的患儿血清乳酸脱氢酶（lactate dehydrogenase, LDH）水平更高（χ²=3.98，P=0.046）。接受过确诊前侵入性操作治疗的患儿中位生存期为1.0年（95%置信区间CI：0.8~1.3），未接受任何此类治疗的患儿中位生存期为1.8年（95%CI：1.4~2.2），两组差异无统计学意义（P=0.961）。

研究结论
确诊前接受侵入性操作治疗会导致骨肉瘤患者的预后更差，这凸显出弥合骨肉瘤诊疗全流程质量差距的必要性。这一举措应包括面向社区与医疗从业者的健康宣教、优化患者转诊流程，以及提升癌症治疗中心的可及性。