Pestieau S R, Jelinek J S, Chang D, Jacquet P, Sugarbaker P H
The Washington Cancer Institute, Washington Hospital Center, DC 20010, USA.
J Am Coll Surg. 2000 Jun;190(6):700-10. doi: 10.1016/s1072-7515(00)00253-2.
Retroperitoneal or visceral sarcoma may recur with disease limited to the abdomen and pelvis. In this clinical situation, further surgical treatments in an attempt to control the disease may be appropriate. CT is used to help select patients for additional surgical interventions.
Preoperative abdominal and pelvic CT scans of 33 patients with recurrent sarcoma were reviewed retrospectively. All patients underwent reoperative surgery and, when appropriate, perioperative intraperitoneal chemotherapy. Patients were divided into two groups according to survival and disease status: alive with no evidence of disease (n = 7) and alive with disease or dead of disease (n = 26). Twenty-two CT indices were studied retrospectively for each patient and evaluated statistically.
The presence of large (greater than 5 cm) tumor volume in 3 of the 13 abdominopelvic regions resulted in a significant difference in the prognosis between the groups of patients. These findings included tumor in the left lower quadrant (p = 0.032), tumor in the pelvis (p = 0.008), and tumor in the distal jejunum (p = 0.032). Two other CT indices that showed a significant difference in survival between the groups were involvement of five abdominopelvic regions or fewer (p = 0.008) and a peritoneal cancer index of 15 or less (p = 0.03). A statistical approach using a tree-structured diagram showed that patients with tumor diameter greater than 5 cm in the pelvis accompanied by tumor involvement of more than one segment of small bowel had a 0% probability of postoperative disease-free survival. In contrast, patients with tumor diameter less than 5 cm in the pelvis on CT had an 86% probability of disease-free survival.
For patients with recurrent sarcoma, selection criteria were generated by a preoperative CT of the abdomen and pelvis. In this disease, CT was a reliable diagnostic test for predicting benefit from further surgical interventions and should be used in the future to help select patients for an aggressive versus a palliative approach.
腹膜后或内脏肉瘤可能复发，且疾病局限于腹部和盆腔。在这种临床情况下，进一步的手术治疗以控制疾病可能是合适的。CT用于帮助选择适合进行额外手术干预的患者。
回顾性分析33例复发性肉瘤患者术前的腹部和盆腔CT扫描结果。所有患者均接受再次手术，并在适当的时候接受围手术期腹腔内化疗。根据生存情况和疾病状态将患者分为两组：无疾病证据存活（n = 7）和有疾病存活或死于疾病（n = 26）。对每位患者回顾性研究22项CT指标并进行统计学评估。
13个腹盆腔区域中有3个区域存在大（大于5 cm）肿瘤体积，这导致两组患者的预后存在显著差异。这些发现包括左下腹肿瘤（p = 0.032）、盆腔肿瘤（p = 0.008）和空肠远端肿瘤（p = 0.032）。另外两个在两组间生存情况有显著差异的CT指标是累及五个或更少的腹盆腔区域（p = 0.008）和腹膜癌指数为15或更低（p = 0.03）。使用树形图的统计方法显示，盆腔肿瘤直径大于5 cm且伴有小肠多个节段受累的患者术后无病生存概率为0%。相比之下，CT显示盆腔肿瘤直径小于5 cm的患者无病生存概率为86%。
对于复发性肉瘤患者，通过术前腹部和盆腔CT制定了选择标准。在这种疾病中，CT是预测进一步手术干预获益的可靠诊断测试，未来应用于帮助选择积极治疗与姑息治疗的患者。
