Matsumoto Seiichi, Ahmed Adel Refaat, Kawaguchi Noriyoshi, Manabe Jun, Matsushita Yasushi
Department of Orthopedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Int J Clin Oncol. 2003 Apr;8(2):104-9. doi: 10.1007/s101470300018.
To address the prognosis and the role of surgery in the management of patients with malignant fibrous histiocytoma (MFH), strict definition and accurate evaluation of local recurrence is mandated, together with adequate gross and microscopic evaluation of the achieved surgical margins.
One hundred and twenty-three patients with MFH were retrospectively analyzed regarding prognostic factors of the disease, which included the following: (1). primary or recurrent, (2). histological grade, (3). adjuvant chemotherapy, (4). size, (5). local recurrence after primary surgery done at the authors' institute, (6). adjuvant radiotherapy, and (7). surgical margin. Initially, all patients were metastasis-free (M0N0).
Local recurrence after primary surgery done at the authors' institute was the most significant prognostic factor, where 20 of 123 patients developed local recurrence ( P < 0.0001). The cause of local recurrence were insufficient surgical margin in 16 patients, while in 4, local recurrences were related to lymph node metastasis, skip metastasis, and tumor embolism. The local recurrence rate for each surgical procedure was 75% for intralesional, 44.4% for marginal, 30.8% for inadequate wide, 12.3% for adequate wide, and 5% for curative procedures. In patients with a history of recurrent tumor or infiltrative pattern, local recurrence was not observed after a curative procedure, but occurred even after an adequate wide procedure.
To improve the prognosis of MFH, surgical prevention of local recurrence is essential. An adequate wide procedure for primary tumors and a curative procedure for recurrent tumors and tumors with an infiltrative pattern provide safe surgical margins.
为了明确恶性纤维组织细胞瘤（MFH）患者的预后情况以及手术在其治疗中的作用，需要对局部复发进行严格定义和准确评估，同时要对手术切缘进行充分的大体和显微镜评估。
回顾性分析123例MFH患者的疾病预后因素，包括：（1）原发或复发；（2）组织学分级；（3）辅助化疗；（4）肿瘤大小；（5）在作者所在机构进行初次手术后的局部复发情况；（6）辅助放疗；（7）手术切缘。最初，所有患者均无转移（M0N0）。
在作者所在机构进行初次手术后的局部复发是最显著的预后因素，123例患者中有20例发生局部复发（P<0.0001）。局部复发的原因中，16例是手术切缘不足，4例与淋巴结转移、跳跃转移和肿瘤栓塞有关。每种手术方式的局部复发率分别为：病灶内手术75%，边缘性手术44.4%，不充分广泛切除30.8%，充分广泛切除12.3%，根治性手术5%。有肿瘤复发史或浸润性生长模式的患者，根治性手术后未观察到局部复发，但即使是充分广泛切除后仍会发生局部复发。
为改善MFH的预后，手术预防局部复发至关重要。对原发性肿瘤采用充分广泛切除，对复发性肿瘤和浸润性生长模式的肿瘤采用根治性手术可提供安全的手术切缘。
