Stojadinovic Alexander, Leung Denis H Y, Allen Peter, Lewis Jonathan J, Jaques David P, Brennan Murray F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Clin Oncol. 2002 Nov 1;20(21):4344-52. doi: 10.1200/JCO.2002.07.154.
To define prognostic factors for postrelapse survival and their time-dependent influence for adult soft tissue sarcoma (STS).
We analyzed 2,123 patients with completely resected localized primary STS treated from 1982 to 1999. Variables studied included tumor site, size, depth, grade, and resection margin but not treatment other than resection. Landmark time frames were used to assess the influence of disease-free interval (DFI) on disease-specific survival (DSS). DSS was estimated with the Kaplan-Meier method. Univariate and multivariate analyses were performed using log-rank test and the Cox proportional hazards regression model. Time-dependent stepwise regression analysis evaluated the time-dependent influence of each variable.
Two thirds of recurrences developed within 2 years of initial resection. Tumor size (P <.001), grade (P <.001), and microscopic resection margin (P <.001) independently predicted DSS for all STS. Size and grade independently predicted early (DFI <or= 3 years) and margin late (DFI > 3 years) DSS. Risk of tumor-related death was the same across all sites 3 years postresection and decreased significantly for extremity/trunk STS when DFI exceeded 3 years (P <.001). Influence of initial high-risk factors for tumor-related mortality in extremity/trunk STS decreased by 40% 3 years postresection, but their influence over DSS for non-extremity/trunk sites remained constant over time. Likelihood of complete resection after recurrence (all sites) increased with DFI (9% and 33% for DFI < 6 and > 36 months, respectively).
Tumor size, grade, and resection margin predict outcome for completely resected STS, and their influence for DSS is time- and site-dependent. The influence of prognostic factors changes over the natural history of extremity/trunk STS. Time to recurrence exerts significant influence over complete resection rates for recurrent disease.
确定成人软组织肉瘤（STS）复发后生存的预后因素及其随时间变化的影响。
我们分析了1982年至1999年期间接受完全切除的局限性原发性STS的2123例患者。研究的变量包括肿瘤部位、大小、深度、分级和切除边缘，但不包括除切除之外的治疗。采用标志性时间框架来评估无病间期（DFI）对疾病特异性生存（DSS）的影响。DSS采用Kaplan-Meier法估计。使用对数秩检验和Cox比例风险回归模型进行单因素和多因素分析。时间依赖性逐步回归分析评估每个变量的时间依赖性影响。
三分之二的复发发生在初次切除后的2年内。肿瘤大小（P<.001）、分级（P<.001）和显微镜下切除边缘（P<.001）独立预测所有STS的DSS。大小和分级独立预测早期（DFI≤3年）和边缘晚期（DFI>3年）DSS。切除后3年所有部位肿瘤相关死亡风险相同，当DFI超过3年时，肢体/躯干STS的风险显著降低（P<.001）。肢体/躯干STS中与肿瘤相关死亡率的初始高危因素的影响在切除后3年降低了40%，但其对非肢体/躯干部位DSS的影响随时间保持不变。复发后完全切除的可能性（所有部位）随DFI增加（DFI<6个月和>36个月时分别为9%和33%）。
肿瘤大小、分级和切除边缘可预测完全切除的STS的预后，它们对DSS的影响具有时间和部位依赖性。预后因素的影响在肢体/躯干STS的自然病程中会发生变化。复发时间对复发性疾病的完全切除率有显著影响。
