Gross Jefferson Luiz, Younes Riad Naim, Haddad Fabio José, Deheinzelin Daniel, Pinto Clovis Antonio Lopes, Costa Marcelo Leite Vieira
Department of Thoracic Surgery, Hospsital do Cancer A.C. Camargo, Sao Paulo, Brazil.
Chest. 2005 Mar;127(3):902-8. doi: 10.1378/chest.127.3.902.
To evaluate factors that are predictive of outcome for patients with chest wall soft-tissue sarcomas.
A retrospective review of 55 surgically treated patients, from March 1964 to October 1996.
The median age of the patients was 47.5 years (age range, 15 to 76.3 years), and 56.4% were men. The most common presenting symptom was chest wall mass in 29 patients (52.7%). The median symptom duration was 12 months. Tumor size ranged from 1 to 26 cm (median size, 9.7 cm). The most common histologic type of tumor was fibrosarcoma (52.7%). Twenty-three sarcomas (41.8%) were high-grade, and 32 sarcomas (52.8%) were low-grade. Of the 55 patients, 27 (49.1%) had previously been treated elsewhere (surgical resection, 23 patients; radiation therapy and surgery, 3 patients; chemoradiation therapy, 1 patient). Previously treated patients presented either with residual disease (10 cases) or recurrence of disease (17 cases). All 55 patients underwent surgical resection, 15 patients (27.3%) were treated by neoadjuvant chemoradiation therapy, and 2 patients were treated by adjuvant radiotherapy. Wide surgical resection was performed in 45 patients (81.8%), and marginal resection was performed in 10 patients (18.2%). The median follow-up time was 51.9 months. Local recurrence of disease developed in 6 patients, and metastases developed in 10 patients. The overall survival rates at 5 and 10 years were 87.3% and 79.3%, respectively. Tumor size < 5 cm and low histologic grade were determinants of better survival at univariate analyses. Multivariate analyses disclosed only histologic grade as an independent predictor for the risk of death. Disease-free survival rates at 5 and 10 years were 75.3% and 64.2%, respectively. Tumor size < 5 cm, performance of wide surgical resection, and low histologic grade were determinants of a better disease-free survival rate. Independent prognostic factors for disease-free survival were histologic grade and type of surgical resection.
The clinical behavior of chest wall soft-tissue sarcomas is similar to that of extremity sarcomas. Thoracic wall soft-tissue sarcomas are best controlled by wide surgical resection.
评估胸壁软组织肉瘤患者预后的预测因素。
回顾性分析1964年3月至1996年10月间55例接受手术治疗的患者。
患者的中位年龄为47.5岁（年龄范围15至76.3岁），男性占56.4%。最常见的首发症状是胸壁肿块，共29例（52.7%）。症状持续时间的中位数为12个月。肿瘤大小为1至26厘米（中位大小9.7厘米）。最常见的肿瘤组织学类型是纤维肉瘤（52.7%）。23例肉瘤（41.8%）为高级别，32例肉瘤（52.8%）为低级别。55例患者中，27例（49.1%）曾在其他地方接受过治疗（手术切除23例；放疗和手术3例；放化疗1例）。既往接受过治疗的患者出现残留病灶（10例）或疾病复发（17例）。所有55例患者均接受了手术切除，15例患者（27.3%）接受了新辅助放化疗，2例患者接受了辅助放疗。45例患者（81.8%）进行了广泛手术切除，10例患者（18.2%）进行了边缘切除。中位随访时间为51.9个月。6例患者出现疾病局部复发，10例患者出现转移。5年和10年的总生存率分别为87.3%和79.3%。单因素分析显示，肿瘤大小<5厘米和低组织学分级是生存较好的决定因素。多因素分析仅显示组织学分级是死亡风险的独立预测因素。5年和10年的无病生存率分别为75.3%和64.2%。肿瘤大小<5厘米、进行广泛手术切除和低组织学分级是无病生存率较好的决定因素。无病生存的独立预后因素是组织学分级和手术切除类型。
胸壁软组织肉瘤的临床行为与肢体肉瘤相似。胸壁软组织肉瘤最好通过广泛手术切除来控制。
