Massi D, Beltrami G, Mela M M, Pertici M, Capanna R, Franchi A
Department of Human Pathology and Oncology, University of Florence, Viale Morgagni, 85, 50134 Firenze, Italy.
Eur J Surg Oncol. 2004 Jun;30(5):565-72. doi: 10.1016/j.ejso.2004.03.002.
Soft tissue leiomyosarcomas (LMS) are rare tumours which are associated with a poor prognosis. The goals of the present study were to describe the clinico-pathological and prognostic features of 42 patients affected by soft tissue LMS of the extremities.
The following clinical and pathological parameters were analysed: age, sex, site, size, depth, previous surgical procedures, stage, histological type, nuclear atypia, grade, mitotic activity, necrosis, surgical margins, therapy. Disease-free survival rates were calculated.
The overall 2-year and 5-year disease free survival rates were 42.3% and 32.6%, respectively. By univariate analysis, tumour size (< or =10 cm vs. >10 cm; p = 0.01), average mitotic rate (< or =19/10 HPF vs. >19/10 HPF; p = 0.05), type of excision (wide vs. marginal or intralesional; p = 0.001) and adjuvant radiotherapy (none vs. brachytherapy+external beam radiotherapy vs. external beam radiotherapy; p = 0.02) were significantly correlated with disease progression. By multivariate analysis, the only factor that was found to be an independent predictor of disease relapse was type of excision (p = 0.001).
Large tumour size and high mitotic rate resulted adverse prognostic factors. Adjuvant radiation therapy, in combination with wide surgical excision, allowed the best chance of cure.
软组织平滑肌肉瘤（LMS）是罕见肿瘤，预后较差。本研究的目的是描述42例四肢软组织LMS患者的临床病理及预后特征。
分析以下临床和病理参数：年龄、性别、部位、大小、深度、既往手术情况、分期、组织学类型、核异型性、分级、有丝分裂活性、坏死、手术切缘、治疗。计算无病生存率。
总体2年和5年无病生存率分别为42.3%和32.6%。单因素分析显示，肿瘤大小（≤10 cm与＞10 cm；p = 0.01）、平均有丝分裂率（≤19/10高倍视野与＞19/10高倍视野；p = 0.05）、切除类型（广泛切除与边缘切除或病灶内切除；p = 0.001）和辅助放疗（无放疗与近距离放疗+外照射放疗与外照射放疗；p = 0.02）与疾病进展显著相关。多因素分析发现，唯一被确定为疾病复发独立预测因素的是切除类型（p = 0.001）。
肿瘤体积大及有丝分裂率高是不良预后因素。辅助放疗联合广泛手术切除有最佳治愈机会。
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