Karavasilis Vasilios, Seddon Beatrice M, Ashley Susan, Al-Muderis Omar, Fisher Cyril, Judson Ian
Royal Marsden Hospital, London, England, United Kingdom.
Cancer. 2008 Apr 1;112(7):1585-91. doi: 10.1002/cncr.23332.
The efficacy of palliative chemotherapy was investigated in a large group of patients with advanced soft-tissue sarcomas (STS) treated on routine palliative protocols.
Patients with STS who had first-line chemotherapy for advanced and/or metastatic disease between 1991 and 2005 were identified from the Royal Marsden Hospital's sarcoma database. Patients with Ewing sarcoma, rhabdomyosarcoma, desmoplastic small round cell tumor, and gastrointestinal stromal tumors were excluded from the study.
In all, 488 patients (242 male, 246 female) fulfilled the study criteria. The median age was 49 years and the majority (83%) received chemotherapy for metastatic disease. The most common histologic subtypes were leiomyosarcoma (35%) synovial sarcoma (13%), liposarcoma (10%), and malignant fibrous histiocytoma (10%). In all, 61% received single-agent chemotherapy, usually doxorubicin. An objective response was reported in 33% of patients (53% in those with synovial sarcoma); 22% had stable disease and 45% derived 'clinical benefit' (objective responses + stable disease for >or= 6 months). Median duration of response was 9 months and median posttreatment overall survival (OS) was 12 months. In multivariate analysis, age <40 years, liposarcoma, and synovial histology were found to be positive, and bone involvement to be negative, independent prognostic factors. Patients treated with combination chemotherapy experienced longer OS than those treated with a single agent.
Palliative chemotherapy may be beneficial in approximately half of patients with advanced STS. Synovial sarcoma and liposarcoma subtypes have a better prognosis. However, the overall poor outcome of these patients indicates the need to continue the search for more effective agents.
在一大组接受常规姑息治疗方案的晚期软组织肉瘤(STS)患者中研究了姑息化疗的疗效。
从皇家马斯登医院肉瘤数据库中识别出1991年至2005年间接受一线化疗治疗晚期和/或转移性疾病的STS患者。尤因肉瘤、横纹肌肉瘤、促纤维组织增生性小圆细胞肿瘤和胃肠道间质瘤患者被排除在研究之外。
共有488例患者(男性242例,女性246例)符合研究标准。中位年龄为49岁,大多数(83%)接受转移性疾病化疗。最常见的组织学亚型为平滑肌肉瘤(35%)、滑膜肉瘤(13%)、脂肪肉瘤(10%)和恶性纤维组织细胞瘤(10%)。共有61%的患者接受单药化疗,通常为多柔比星。33%的患者报告有客观缓解(滑膜肉瘤患者中为53%);22%病情稳定,45%获得“临床获益”(客观缓解+病情稳定≥6个月)。中位缓解持续时间为9个月,中位治疗后总生存期(OS)为12个月。多变量分析发现,年龄<40岁、脂肪肉瘤和滑膜组织学为阳性预后因素,骨受累为阴性预后因素。接受联合化疗的患者比接受单药化疗的患者OS更长。
姑息化疗可能对约一半的晚期STS患者有益。滑膜肉瘤和脂肪肉瘤亚型预后较好。然而,这些患者总体预后较差,表明需要继续寻找更有效的药物。