Stojadinovic A, Hoos A, Karpoff H M, Leung D H, Antonescu C R, Brennan M F, Lewis J J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Arch Surg. 2001 Jan;136(1):70-9. doi: 10.1001/archsurg.136.1.70.
Abdominal wall tumors, though clinically similar, have varying degrees of biological behavior.
Retrospective review of prospective databases.
Memorial Sloan-Kettering Cancer Center.
Eighty-five patients with abdominal wall soft tissue tumors.
Primary endpoints included time to first local recurrence, distant metastases, and disease-related mortality. Survival analysis was performed by Kaplan-Meier method, and comparisons were made by log-rank analysis.
Thirty-nine desmoids, 32 soft tissue sarcomas (STS), and 14 dermatofibrosarcoma protuberans (DFSP) underwent surgery directed at achieving margin-negative resection. Unlike DFSP, most STS (77%) and desmoids(87%) were deep lesions requiring full-thickness abdominal wall resection and mesh reconstruction. Median follow-up time was 53 months, 101 months, and 31 months, with 5-year local recurrence-free survival rates of 97%, 100%, and 75%, for desmoids, DFSP, and STS, respectively. Desmoid tumors resected with positive microscopic margins had higher local failure rates (68% [positive margin] vs 100% [negative margin] 5-yr local recurrence-free survival, P<.05). For STS, high grade, deep location, and size at or above 5 cm were adverse prognostic factors for disease-specific and distant recurrence-free survival (P<.05); patients experiencing local recurrence was associated with decreased 5-year relapse-free survival rates (87% [primary] vs 50% [local recurrence], P<.05). Characteristically, no DFSP or desmoid developed distant metastases. Soft tissue sarcomas had significantly lower relapse-free survival rates than DFSP or desmoids (P<.05).
Abdominal wall tumors demonstrate a broad spectrum of biological behavior. Desmoids and DFSP are a local problem. High grade, size at or above 5 cm, and deep location predict distant failure and tumor-related mortality for patients with STS. Complete surgical resection is the recommended treatment approach to achieve local control. Stratification by prognostic factors will facilitate selection of patients with STS for adjuvant systemic therapies.
腹壁肿瘤尽管在临床上相似，但具有不同程度的生物学行为。
对前瞻性数据库进行回顾性分析。
纪念斯隆凯特琳癌症中心。
85例腹壁软组织肿瘤患者。
主要终点包括首次局部复发时间、远处转移和疾病相关死亡率。采用Kaplan-Meier法进行生存分析，并通过对数秩检验进行比较。
39例硬纤维瘤、32例软组织肉瘤（STS）和14例隆突性皮肤纤维肉瘤（DFSP）接受了旨在实现切缘阴性切除的手术。与DFSP不同，大多数STS（77%）和硬纤维瘤（87%）是深部病变，需要进行全层腹壁切除和网片重建。中位随访时间分别为53个月、101个月和31个月，硬纤维瘤、DFSP和STS的5年无局部复发生存率分别为97%、100%和75%。显微镜下切缘阳性的硬纤维瘤肿瘤局部失败率更高（5年无局部复发生存率：切缘阳性为68%，切缘阴性为100%，P<0.05）。对于STS，高级别、深部位置以及大小在5 cm及以上是疾病特异性和无远处复发生存的不良预后因素（P<0.05）；发生局部复发的患者5年无复发生存率降低（初次为87%，局部复发为50%，P<0.05）。典型的是，没有DFSP或硬纤维瘤发生远处转移。软组织肉瘤的无复发生存率明显低于DFSP或硬纤维瘤（P<0.05）。
腹壁肿瘤表现出广泛的生物学行为。硬纤维瘤和DFSP是局部问题。高级别、大小在5 cm及以上和深部位置可预测STS患者的远处失败和肿瘤相关死亡率。建议采用完整手术切除以实现局部控制。根据预后因素进行分层将有助于选择STS患者进行辅助全身治疗。
