Serpell J W, Ball A B, Robinson M H, Fryatt I, Fisher C, Thomas J M
Department of Surgery, Royal Marsden Hospital, London, UK.
Br J Surg. 1991 Nov;78(11):1368-72. doi: 10.1002/bjs.1800781132.
Fifty-one patients with soft tissue sarcoma of the upper limb were studied to identify risk factors for local recurrence and survival. More than half (53 per cent) of the patients referred had locally recurrent disease. The flexor aspect of the forearm was the most common site of origin. The majority of patients were managed by a combination of conservative surgery and radical radiotherapy. Wide or radical excision was achieved in 49 per cent of cases. One-third of patients required partial resection of bone or neurovascular structures; 75 per cent of them had presented with local recurrence after treatment elsewhere. Skin grafts and flap repairs were used more often in patients with local recurrence (P = 0.013) and 20 (74 per cent) of those referred with locally recurrent disease have had no further local relapse. The overall 5-year survival rate of 80 per cent (95 per cent confidence interval 61-90 per cent) supports a policy of conservative surgery. Factors associated with a lower survival rate were deep fixation, origin in the flexor aspect of the forearm, and previous local recurrence. Deep fixation was also associated with an increased risk of local recurrence. Referral to a specialist unit at the time of initial presentation may result in lower rates of local recurrence and may improve the survival rate.
对51例上肢软组织肉瘤患者进行了研究，以确定局部复发和生存的危险因素。超过一半（53%）的转诊患者患有局部复发性疾病。前臂屈侧是最常见的起源部位。大多数患者采用保守手术和根治性放疗相结合的方法进行治疗。49%的病例实现了广泛或根治性切除。三分之一的患者需要部分切除骨骼或神经血管结构；其中75%的患者在其他地方接受治疗后出现了局部复发。局部复发的患者更常使用皮肤移植和皮瓣修复（P = 0.013），20例（74%）转诊的局部复发性疾病患者没有进一步的局部复发。80%的总体5年生存率（95%置信区间61 - 90%）支持保守手术策略。与较低生存率相关的因素包括深部固定、起源于前臂屈侧以及既往局部复发。深部固定也与局部复发风险增加有关。初次就诊时转诊至专科单位可能会降低局部复发率，并可能提高生存率。
