Gutierrez Juan C, Perez Eduardo A, Franceschi Dido, Moffat Frederick L, Livingstone Alan S, Koniaris Leonidas G
DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
J Surg Res. 2007 Jul;141(1):105-14. doi: 10.1016/j.jss.2007.02.026. Epub 2007 May 18.
To date, outcome reports for soft-tissue sarcoma (STS) have largely been limited to single or paired institutional series. To more accurately elucidate population-based outcomes and prognostic factors associated with STS, a large cancer registry was examined.
STS arising in the Florida Cancer Data System were examined (1981-2004).
A total of 8249 patients were identified, the calculated annual incidence of sarcoma being approximately 38 cases per million in 2003. The tumor histologies among these patients were leiomyosarcoma and gastrointestinal stromal tumor (LMS/GIST) (43.5%), malignant fibrous histiocytoma (MFH) (31.5%), liposarcoma (19.0%), and fibrosarcoma (6.0%). Tumors were situated in the extremities (30.7%), truncal or visceral locations (50.4%), retroperitoneum (11.7%), and head or neck (7.2%). Thirty-three percent of lesions were over 10 cm in greatest dimension, while 50.2% were classified as high grade. Median overall survival was 25 months. Superior survival was observed for liposarcomas and fibrosarcomas as compared to MFH and LMS/GIST (P < 0.001). Retroperitoneal and truncal sarcomas had a more ominous prognosis than did other sites (P < 0.001). Multivariate analysis of pretreatment variables demonstrated that increasing age, male gender, non-Caucasian race, advanced stage, and a truncal or retroperitoneal location were each independently associated with lower survival. Histological subtype was also an independent predictor of outcome. Surgical resection and radiation therapy were the only treatment variables shown to improve survival.
Histological subtype, tumor site, and stage are independent prognostic factors in STS. Surgical resection and radiotherapy are unique among treatment modalities in association with a significant survival benefit.
迄今为止，软组织肉瘤（STS）的疗效报告大多局限于单个或配对的机构系列研究。为了更准确地阐明基于人群的STS预后及相关预后因素，我们对一个大型癌症登记处进行了研究。
对佛罗里达癌症数据系统中出现的STS进行研究（1981 - 2004年）。
共识别出8249例患者，2003年肉瘤的计算年发病率约为每百万人口38例。这些患者的肿瘤组织学类型包括平滑肌肉瘤和胃肠道间质瘤（LMS/GIST）（43.5%）、恶性纤维组织细胞瘤（MFH）（31.5%）、脂肪肉瘤（19.0%）和纤维肉瘤（6.0%）。肿瘤位于四肢（30.7%）、躯干或内脏部位（50.4%）、腹膜后（11.7%）以及头颈部（7.2%）。33%的病灶最大直径超过10 cm，而50.2%被归类为高级别。中位总生存期为25个月。与MFH和LMS/GIST相比，脂肪肉瘤和纤维肉瘤的生存期更长（P < 0.001）。腹膜后和躯干肉瘤的预后比其他部位更差（P < 0.001）。对治疗前变量的多因素分析表明，年龄增加、男性、非白种人、晚期以及躯干或腹膜后位置均与较低的生存率独立相关。组织学亚型也是预后的独立预测因素。手术切除和放射治疗是仅有的显示能提高生存率的治疗变量。
组织学亚型、肿瘤部位和分期是STS的独立预后因素。手术切除和放疗在治疗方式中具有独特性，与显著的生存获益相关。
