Grimer Robert J
Oncology Service, Royal Orthopaedic Hospital, Birmingham, UK.
Ann R Coll Surg Engl. 2006 Oct;88(6):519-24. doi: 10.1308/003588406X130651.
By the time of diagnosis, sarcomas have frequently reached a large size and many patients have a long history of symptoms prior to diagnosis. The aim of this study was to assess whether size of tumour at presentation or duration of symptoms was a significant factor affecting outcome.
A prospective database recording patient, tumour, treatment and outcome factors was reviewed. A total of 1460 patients with newly diagnosed sarcomas and with > 3 years of follow-up were included for analysis.
The mean size of sarcomas presenting to our unit was 10.7 cm at the time of diagnosis. Bone sarcomas averaged 11.3 cm with little variation by age or diagnosis, whilst subcutaneous soft tissue sarcomas averaged 10 cm. The incidence of metastases at diagnosis increased almost linearly with increasing size and the prognosis, even for patients without metastases at diagnosis became steadily worse with increasing size for all tumours, independent of other factors. Duration of symptoms did not correlate with size but patients with symptoms > 1 year had a slightly better prognosis than those with a shorter duration.
The author makes a plea for greater awareness of potential malignancy in lumps and bumps, particularly those over the size of a golf ball (4.27 cm), making the point that the smaller the tumour at diagnosis the better the prognosis.
在确诊时，肉瘤通常已长得很大，而且许多患者在确诊前已有很长时间的症状史。本研究的目的是评估就诊时肿瘤大小或症状持续时间是否是影响预后的重要因素。
回顾了一个记录患者、肿瘤、治疗及预后因素的前瞻性数据库。共纳入1460例新诊断的肉瘤患者且随访时间超过3年进行分析。
我院就诊的肉瘤确诊时平均大小为10.7厘米。骨肉瘤平均为11.3厘米，在年龄或诊断方面变化不大，而皮下软组织肉瘤平均为10厘米。确诊时转移的发生率几乎随肿瘤大小增加呈线性上升，并且对于所有肿瘤而言，即使是确诊时无转移的患者，其预后也随着肿瘤大小增加而逐渐变差，与其他因素无关。症状持续时间与肿瘤大小无关，但症状持续超过1年的患者预后略好于症状持续时间较短的患者。
作者呼吁对肿块尤其是那些超过高尔夫球大小（4.27厘米）的肿块可能存在的恶性肿瘤提高认识，指出确诊时肿瘤越小预后越好。
