Russo P, Brady M S, Conlon K, Hajdu S I, Fair W R, Herr H W, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
J Urol. 1992 Apr;147(4):1032-6; discussion 1036-7. doi: 10.1016/s0022-5347(17)37456-6.
From July 1982 to December 1989, 43 of 1,583 adults (2.7%) with soft tissue sarcoma admitted to the Memorial Sloan-Kettering Cancer Center (MSKCC) had tumors arising from the urinary tract and male genital tract (urological sarcoma). The most common site of origin of the tumor was paratesticular (14 patients), followed by the prostate/seminal vesicle (12), bladder (10) and kidney (7). The most common histological type was leiomyosarcoma (19 patients), followed by rhabdomyosarcoma (14), liposarcoma (5) and 5 other histological sarcoma categories (angiosarcoma, malignant fibrous histiocytoma, mesenchymoma and 2 undifferentiated sarcomas). Most of the tumors were high grade (86%) and more than half (56%) were greater than 5 cm. in diameter. A total of 9 patients (21%) presented with metastatic disease, 8 of whom had rhabdomyosarcoma. Complete resection with negative microscopic margins was possible in 58% of the patients. Actuarial relapse-free survival for all patients at 3 and 5 years was 55% and 40%, respectively. There were no significant differences in survival based on patient age, sex or histological tumor type. Favorable prognostic variables by univariate analysis included tumor diameter less than 5 cm., low histological grade, paratesticular or bladder tumor site and complete surgical resection. Application of the MSKCC sarcoma staging system, which is based on grade, size, depth and presence or absence of metastasis, was useful to predict survival. In our experience patients with stage 3 (high grade, greater than 5 cm., 15 patients) or stage 4 (metastatic disease, 9 patients) had a combined 3-year relapse-free survival rate of only 26% and they should be considered candidates for adjuvant treatment protocols.
1982年7月至1989年12月，纪念斯隆 - 凯特琳癌症中心（MSKCC）收治的1583例软组织肉瘤成年患者中，有43例（2.7%）肿瘤起源于泌尿道和男性生殖道（泌尿系统肉瘤）。肿瘤最常见的起源部位是睾丸旁（14例患者），其次是前列腺/精囊（12例）、膀胱（10例）和肾脏（7例）。最常见的组织学类型是平滑肌肉瘤（19例患者），其次是横纹肌肉瘤（14例）、脂肪肉瘤（5例）以及其他5种组织学肉瘤类型（血管肉瘤、恶性纤维组织细胞瘤、间叶瘤和2例未分化肉瘤）。大多数肿瘤为高级别（86%），超过一半（56%）直径大于5厘米。共有9例患者（21%）出现转移性疾病，其中8例为横纹肌肉瘤。58%的患者能够实现显微镜下切缘阴性的完整切除。所有患者3年和5年的无复发生存率分别为55%和40%。基于患者年龄、性别或肿瘤组织学类型的生存率无显著差异。单因素分析显示，有利的预后变量包括肿瘤直径小于5厘米、低组织学分级、睾丸旁或膀胱肿瘤部位以及完整的手术切除。基于分级、大小、深度和有无转移的MSKCC肉瘤分期系统，有助于预测生存率。根据我们的经验，3期（高级别，大于5厘米，15例患者）或4期（转移性疾病，9例患者）患者的3年无复发生存率仅为26%，他们应被视为辅助治疗方案的候选者。
