Yeh C Y, Chen H H, Tang R, Tasi W S, Lin P Y, Wang J Y
Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Dis Colon Rectum. 2000 Nov;43(11):1517-21. doi: 10.1007/BF02236730.
The aim of this study is to present the prognosis and possible associated prognostic factors after curative resection of rectal leiomyosarcoma.
From 1979 to 1996 our hospital saw 40 patients with rectal leiomyosarcoma, including 19 females, who did not have metastasis initially and received curative resection and regular postoperative follow-up.
The mean age of the 40 patients was 58.7 years. Anal bleeding and perianal pain were the two most common symptoms at initial diagnosis. Twenty-nine patients received a radical surgical resection, such as abdominoperineal resection or low anterior resection; the other 11 patients received a wide local excision, such as transrectal excision or Kraske's operation. Sixteen tumors were classified as high-grade leiomyosarcoma, and 23 as low grade. Nineteen patients (48 percent) developed recurrence or metastasis postoperatively (median follow-up, 35 months). The overall and disease-free (1-year, 3-year, and 5-year) survival rates were 97, 90, and 75 percent and 90, 59, and 46 percent, respectively. In univariate analysis, younger group (<50 years, n = 9, P = 0.033) and high-grade leiomyosarcoma (P = 0.043) showed poorer prognosis in the disease-free survival curve. In the multivariate Cox model, gender, tumor size, tumor location, and operation type did not significantly affect disease-free survival, whereas histologic grade (P = 0.037) and age divided by a level of 50 years (P = 0.009) were shown to be independent factors. There was a strong trend toward higher local recurrence rate for the wide local excision group than for the radical resection group (55 vs. 24 percent, P = 0.067) despite the wide local excision group being composed of smaller tumors (5.1 vs. 7.5 cm, P = 0.069). There was no difference in the incidence of distant metastasis between the two groups with different operation types. The metastasis rates of the wide local excision and radical resection groups were 27 and 38 percent, respectively.
A younger age (<50 years) and a high histologic grade of tumor were the two most significant poor prognostic factors for rectal leiomyosarcoma. Radical resection may be superior to wide local excision in the prevention of local recurrence but not distant metastasis.
本研究旨在阐述直肠平滑肌肉瘤根治性切除术后的预后情况及可能相关的预后因素。
1979年至1996年，我院共收治40例直肠平滑肌肉瘤患者，其中女性19例，这些患者最初均无转移，接受了根治性切除及术后定期随访。
40例患者的平均年龄为58.7岁。肛门出血和肛周疼痛是初诊时最常见的两种症状。29例患者接受了根治性手术切除，如腹会阴联合切除术或低位前切除术；另外11例患者接受了广泛局部切除术，如经直肠切除术或克拉斯克手术。16例肿瘤被归类为高级别平滑肌肉瘤，23例为低级别。19例患者（48%）术后出现复发或转移（中位随访时间为35个月）。总体生存率及无病生存率（1年、3年和5年）分别为97%、90%和75%以及90%、59%和46%。单因素分析显示，较年轻组（<50岁，n = 9，P = 0.033）和高级别平滑肌肉瘤（P = 0.043）在无病生存曲线上预后较差。在多因素Cox模型中，性别、肿瘤大小、肿瘤位置和手术方式对无病生存无显著影响，而组织学分级（P = 0.037）和以50岁为界划分的年龄（P = 0.009）被证明是独立因素。尽管广泛局部切除组的肿瘤较小（5.1 vs. 7.5 cm，P = 0.069），但该组局部复发率有高于根治性切除组的强烈趋势（55% vs. 24%，P = 0.067）。不同手术方式的两组远处转移发生率无差异。广泛局部切除组和根治性切除组的转移率分别为27%和38%。
较年轻年龄（<50岁）和肿瘤的高组织学分级是直肠平滑肌肉瘤两个最显著的不良预后因素。根治性切除在预防局部复发方面可能优于广泛局部切除，但在预防远处转移方面并非如此。
