Billingsley K G, Lewis J J, Leung D H, Casper E S, Woodruff J M, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Cancer. 1999 Jan 15;85(2):389-95.
Despite optimal multimodality limb-sparing therapy for extremity soft tissue sarcoma (STS), a significant number of patients develop distant metastasis. The objective of this study was to analyze patterns of metastatic disease and define prognostic factors for survival in a large group of patients followed prospectively at a single institution.
Between July 1, 1982, and June 30, 1996, all adult patients admitted to the Memorial Sloan-Kettering Cancer Center with primary extremity sarcoma were treated and prospectively followed. Patients who developed distant metastases constituted the study group. Prognostic factors were analyzed for postmetastasis survival. These included both factors related to the primary tumor and factors related to the pattern of metastasis. Postmetastasis survival was modeled using the Kaplan-Meier method. Statistical significance was evaluated using the log rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis.
During the study period, the authors admitted and treated 994 patients with primary extremity STS. The median follow-up was 33 months. Distant metastasis developed in 230 patients (23%). Median survival after distant metastasis was 11.6 months. The lungs were the first metastatic site in 169 patients (73%). Other first sites of metastasis included the skin and soft tissues of the head and neck, trunk, and extremities. There was no statistically significant difference in survival between patients with pulmonary and those with nonpulmonary metastatic disease. In multivariate analysis, resection of metastatic disease, the length of the disease free interval, the presence of a preceding local recurrence, and patient age > 50 years all were significant predictors of postmetastasis survival. Other factors that defined the primary tumor, including histologic grade, depth, and microscopic margins, were not associated with postmetastasis survival.
Despite optimal multimodality therapy, 23% of the patients in this series with primary extremity sarcoma developed distant metastasis. Median survival after metastasis was approximately 1 year. After metastasis, the independent favorable factors that are associated with patient survival include resection of the metastases, a long disease free interval, the absence of preceding local recurrence, and patient age < 50 years. Although a definitive conclusion regarding the benefit of resection can be made only with a randomized clinical trial, these data suggest that resection of metastatic STS may contribute to patient survival, which in some cases may be long term.
尽管对肢体软组织肉瘤（STS）采用了最佳的多模式保肢治疗，但仍有相当数量的患者发生远处转移。本研究的目的是分析转移疾病的模式，并确定在单一机构前瞻性随访的一大组患者中的生存预后因素。
在1982年7月1日至1996年6月30日期间，所有因原发性肢体肉瘤入住纪念斯隆凯特琳癌症中心的成年患者均接受治疗并进行前瞻性随访。发生远处转移的患者构成研究组。分析转移后生存的预后因素。这些因素包括与原发性肿瘤相关的因素和与转移模式相关的因素。转移后生存采用Kaplan-Meier方法进行建模。使用对数秩检验进行单变量分析，使用Cox比例风险模型进行多变量分析来评估统计学意义。
在研究期间，作者收治并治疗了994例原发性肢体STS患者。中位随访时间为33个月。230例患者（23%）发生远处转移。远处转移后的中位生存期为11.6个月。肺是169例患者（73%）的首个转移部位。其他首个转移部位包括头颈部、躯干和四肢的皮肤及软组织。肺转移患者和非肺转移疾病患者的生存无统计学显著差异。在多变量分析中，转移疾病的切除、无病间期的长度、先前局部复发的存在以及患者年龄>50岁均是转移后生存的显著预测因素。定义原发性肿瘤的其他因素，包括组织学分级、深度和显微镜下切缘，与转移后生存无关。
尽管采用了最佳的多模式治疗，但本系列中23%的原发性肢体肉瘤患者发生了远处转移。转移后的中位生存期约为1年。转移后，与患者生存相关的独立有利因素包括转移灶的切除、较长的无病间期、无先前局部复发以及患者年龄<50岁。虽然只有通过随机临床试验才能得出关于切除益处的确切结论，但这些数据表明，转移性STS的切除可能有助于患者生存，在某些情况下可能是长期生存。
