Widhe Björn, Bauer Henrik C F
Department of Molecular Medicine and Surgery, Division of Orthopedics, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
J Thorac Cardiovasc Surg. 2009 Mar;137(3):610-4. doi: 10.1016/j.jtcvs.2008.07.024. Epub 2008 Sep 23.
Chondrosarcoma of the chest wall is the most frequent primary malignant chest wall tumor. Surgery remains the only effective treatment. Sarcoma treatment in Sweden is centralized to sarcoma centers; however, sarcomas of the chest wall have also been handled by thoracic and general surgeons.
One hundred six consecutive reports of chondrosarcomas of the rib and sternum over a 22-year period (1980 to 2002) were studied, with a median of 9 (4 to 23) years of follow-up for survivors. Clinical files were gathered and pathologic specimens reviewed and graded 1 to 4 by the Scandinavian sarcoma pathology group. Surgical margins were defined as wide, marginal, or intralesional.
Ninety-seven patients were treated with a curative intent. Patients operated with wide surgical margins had a 10-year survival of 92% compared with 47% for those with intralesional resections. The 10-year survival was 75% for patients treated at sarcoma centers and 59% for those treated by thoracic or general surgeons. Local recurrence rate was highly dependent of the surgical margins-4% after wide resections and 73% after intralesional resections. The proportion of intralesional resections was higher outside sarcoma centers. Prognostic factors (multivariate analysis) for local recurrence included surgical margin and histological grade; for metastases, prognostic factors included histologic grade, tumor size, and local recurrence. Metastases occurred in 21 of the patients and only 2 were cured.
Patients operated with wide surgical margins resulted in fewer local recurrences and better overall survival. Patients with chest wall tumors should be referred to sarcoma centers and not to general thoracic surgery clinics for diagnosis and treatment.
胸壁软骨肉瘤是最常见的原发性恶性胸壁肿瘤。手术仍然是唯一有效的治疗方法。瑞典的肉瘤治疗集中于肉瘤中心；然而，胸壁肉瘤也由胸外科医生和普通外科医生处理。
研究了1980年至2002年22年间连续的106例肋骨和胸骨软骨肉瘤报告，幸存者的中位随访时间为9年（4至23年）。收集临床资料，由斯堪的纳维亚肉瘤病理小组对病理标本进行复查并分级为1至4级。手术切缘定义为广泛、边缘或瘤内。
97例患者接受了根治性治疗。手术切缘广泛的患者10年生存率为92%，而瘤内切除的患者为47%。肉瘤中心治疗的患者10年生存率为75%，胸外科或普通外科医生治疗的患者为59%。局部复发率高度依赖于手术切缘——广泛切除后为4%，瘤内切除后为73%。瘤内切除的比例在肉瘤中心以外更高。局部复发的预后因素（多变量分析）包括手术切缘和组织学分级；对于转移，预后因素包括组织学分级、肿瘤大小和局部复发。21例患者发生转移，仅2例治愈。
手术切缘广泛的患者局部复发较少，总体生存率更高。胸壁肿瘤患者应转诊至肉瘤中心，而不是普通胸外科诊所进行诊断和治疗。
