Gil Ziv, Patel Snehal G, Singh Bhuvanesh, Cantu Giulio, Fliss Dan M, Kowalski Luiz P, Kraus Dennis H, Snyderman Carl, Shah Jatin P
Department of Surgery, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Cancer. 2007 Sep 1;110(5):1033-41. doi: 10.1002/cncr.22882.
Single-institutional studies lack sufficient power to assess the role of surgery and radiotherapy in the management of sarcomas involving the anterior skull base. For this study, an international collaborative study group analyzed a large cohort of patients who underwent surgery for the treatment of skull base tumors.
A subset of 146 patients who had a histologic diagnosis of skull base sarcoma (SBS) formed the basis of this report. Most patients were aged > or =21 years (77%) and had stage IV disease (56%). Adjuvant radiotherapy was received by 35% of patients, and chemotherapy was received by 10% of patients.
Orbital involvement was encountered in 53% of patients, involvement of the orbital wall was encountered in 46% of patients, and intracranial extension was encountered in 28% of patients. Positive microscopic margins were reported in 43% of patients (51 of 118 patients). Treatment-related complications were reported in 27% of patients, and postoperative mortality was reported in 1.4% of patients. With a median follow-up of 34 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 62%, 64%, and 57%, respectively. Tumor grade and adjuvant radiotherapy were not significant predictors of survival. Prior radiotherapy, intraorbital extension, positive margins, and postoperative complications were significant predictors of reduced disease-specific survival on univariate analysis. The presence of positive/close margins, however, was the only independent predictor of poor overall, recurrence-free, and disease-specific survival on multivariate analysis (relative risk, 2.4; P = .006). The 5-year disease-specific survival rate was 77%, 43%, and 36% for patients with negative, close, and positive margins, respectively.
The current results indicated that wide craniofacial resection with negative margins is an independent prognostic predictor of better outcome. Patients with positive margins have a high risk for tumor recurrence independent of tumor grade.
单机构研究缺乏足够的效力来评估手术和放疗在涉及前颅底的肉瘤治疗中的作用。在本研究中,一个国际协作研究小组分析了一大群接受手术治疗颅底肿瘤的患者。
146例经组织学诊断为颅底肉瘤(SBS)的患者亚组构成了本报告的基础。大多数患者年龄≥21岁(77%),且患有IV期疾病(56%)。35%的患者接受了辅助放疗,10%的患者接受了化疗。
53%的患者出现眼眶受累,46%的患者出现眶壁受累,28%的患者出现颅内扩展。43%的患者(118例患者中的51例)报告有显微镜下切缘阳性。27%的患者报告有与治疗相关的并发症,1.4%的患者报告有术后死亡率。中位随访34个月时,5年总生存率、疾病特异性生存率和无复发生存率分别为62%、64%和57%。肿瘤分级和辅助放疗不是生存的显著预测因素。在单因素分析中,既往放疗、眶内扩展、切缘阳性和术后并发症是疾病特异性生存率降低的显著预测因素。然而,在多因素分析中,切缘阳性/接近切缘是总体生存、无复发生存和疾病特异性生存不良的唯一独立预测因素(相对风险,2.4;P = 0.006)。切缘阴性、接近切缘和阳性的患者5年疾病特异性生存率分别为77%、43%和36%。
目前的结果表明,切缘阴性的广泛颅面切除术是预后较好的独立预测因素。切缘阳性的患者无论肿瘤分级如何,肿瘤复发风险都很高。