Williard W C, Collin C, Casper E S, Hajdu S I, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10025.
Surg Gynecol Obstet. 1992 Nov;175(5):389-96.
The role of amputation in soft tissue sarcoma of the extremity has decreased at Memorial Sloan-Kettering Cancer Center during the last 20 years. In an attempt to determine the reasons for this change in therapy, an analysis of two separate databases involving 1,057 patients compiled during the periods of 1968 to 1978 and 1982 to 1990 was performed. The patients requiring amputation for soft tissue sarcoma of the extremity in the two databases (n = 233) were compared in an attempt to determine any significant differences between the two time periods. The groups were specifically compared for differences in risk factors, indications for amputations and the effect a decreasing incidence of amputation in the 1982 to 1990 group had on local recurrence and overall survival between the two groups. Despite similarity of risk factors and indications for amputation, the decreased incidence of amputation during the 1982 to 1990 period was associated with a significant decrease in local recurrence after amputation and no significant change in overall survival compared with the 1968 to 1978 group. Absence of local recurrence was associated with significant improvement in survival. Possible reasons for the shift in therapy, as well as the present and future role of amputation in soft tissue sarcoma of the extremity, are discussed.
在过去20年里，截肢在纪念斯隆 - 凯特琳癌症中心治疗肢体软组织肉瘤中的作用有所下降。为了确定这种治疗方式改变的原因，我们对两个独立数据库进行了分析，这两个数据库收集了1968年至1978年以及1982年至1990年期间的1057例患者的数据。我们比较了两个数据库中因肢体软组织肉瘤需要截肢的患者（n = 233），试图确定这两个时间段之间是否存在任何显著差异。具体比较了两组在风险因素、截肢指征以及1982年至1990年组截肢率下降对两组局部复发和总生存率的影响方面的差异。尽管风险因素和截肢指征相似，但与1968年至1978年组相比，1982年至1990年期间截肢率的下降与截肢后局部复发的显著减少以及总生存率无显著变化相关。无局部复发与生存率的显著提高相关。本文讨论了治疗方式转变的可能原因，以及截肢在肢体软组织肉瘤当前和未来的作用。
