Weitz Jürgen, Antonescu Christina R, Brennan Murray F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
J Clin Oncol. 2003 Jul 15;21(14):2719-25. doi: 10.1200/JCO.2003.02.026.
The objective of this study was to define whether survival of patients with extremity soft tissue sarcoma (STS), stratified for known risk factors, has improved over the last 20 years.
From January 1982 to December 2001, 1,706 patients with primary and recurrent STS of the extremities were treated at our institution and were prospectively followed. From this cohort, we selected 1,261 patients who underwent complete macroscopic resection and had one of the following histopathologies: fibrosarcoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, or synovial sarcoma. Median follow-up was 55 months. Patient, tumor, and treatment factors were analyzed as prognostic factors.
The 5-year disease-specific actuarial survival was 79% (78% for patients treated from 1982 to 1986, 79% for patients treated from 1986 to 1991, 79% for patients treated from 1992 to 1996, and 85% for patients treated from 1997 to 2001; P = not significant). For high-risk patients (high-grade, > 10 cm, deep tumors; n = 247), 5-year disease-specific survival was 51% (50% for patients treated from 1982 to 1986, 45% for patients treated from 1986 to 1991, 52% for patients treated from 1992 to 1996, and 61% for patients treated from 1997 to 2001; P = not significant). Tumor depth, size, grade, microscopic margin status, patient age, presentation status (primary tumor versus local recurrence), location (proximal versus distal), and certain histopathologic subtypes were significant prognostic factors for disease-specific survival on multivariate analysis; however, time period of treatment was not.
Prognosis of patients with extremity STS, stratified for known risk factors, has not improved over the last 20 years, indicating that current therapy has reached the limits of efficacy.
本研究的目的是确定根据已知风险因素分层的四肢软组织肉瘤（STS）患者的生存率在过去20年中是否有所提高。
1982年1月至2001年12月，1706例原发性和复发性四肢STS患者在我们机构接受治疗并进行前瞻性随访。从该队列中，我们选择了1261例接受了完整宏观切除且具有以下组织病理学之一的患者：纤维肉瘤、脂肪肉瘤、平滑肌肉瘤、恶性纤维组织细胞瘤或滑膜肉瘤。中位随访时间为55个月。对患者、肿瘤和治疗因素进行分析作为预后因素。
5年疾病特异性精算生存率为79%（1982年至1986年治疗的患者为78%，1986年至1991年治疗的患者为79%，1992年至1996年治疗的患者为79%，1997年至2001年治疗的患者为85%；P=无显著性差异）。对于高危患者（高级别、>10 cm、深部肿瘤；n=247），5年疾病特异性生存率为51%（1982年至1986年治疗的患者为50%，1986年至1991年治疗的患者为45%，1992年至1996年治疗的患者为52%，1997年至2001年治疗的患者为61%；P=无显著性差异）。多因素分析显示，肿瘤深度、大小、分级、显微镜下切缘状态、患者年龄、表现状态（原发性肿瘤与局部复发）、部位（近端与远端）以及某些组织病理学亚型是疾病特异性生存的显著预后因素；然而，治疗时间段不是。
根据已知风险因素分层的四肢STS患者的预后在过去20年中没有改善，表明当前治疗已达到疗效极限。
