Gordon M S, Hajdu S I, Bains M S, Burt M E
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y. 10021.
J Thorac Cardiovasc Surg. 1991 May;101(5):843-54.
Primary soft tissue sarcomas of the chest wall are uncommon, and data concerning treatment and results are sparse. Most studies have categorized these tumors as truncal sarcomas and inferred a poor prognosis. To assess the results of surgical treatment, we reviewed our 40-year experience.
Records of 189 patients admitted to our institution from 1948 to 1988 were reviewed. Pathologic material was available for review in the 149 cases (79%) that comprise this report. Survival was calculated by the Kaplan-Meier method, with comparisons by log-rank analysis and significance defined as p less than 0.05.
Ages ranged from 3 weeks to 86 years (median, 38 years); the ratio of male to female patients was 2:1. The initial complaint was mass or pain in 97% of the cases. Ninety sarcomas (60%) were high grade and 59 (40%) were low grade. Histologic types were as follows: desmoid tumor (n = 32, 21%); liposarcoma (n = 23, 15%); rhabdomyosarcoma (n = 18, 12%); fibrosarcoma (n = 17, 11%); embryonal rhabdomyosarcoma (n = 14, 9%); malignant peripheral nerve tumor (n = 13, 9%); malignant fibrous histiocytoma (n = 11, 7%); spindle cell sarcoma (n = 4, 3%); tenosynovial sarcoma (n = 3, 3%); hemangiopericytoma (n = 3, 3%); alveolar soft part sarcoma (n = 3, 3%); and other types (n = 12, 9%). Resection was the primary treatment in 140 cases (94%). Local recurrence developed in 27%. Metastases occurred in 52 (35%) of the cases (metachronous in 42, synchronous in 10) and were more common in patients with high-grade disease (46/90, 51%) than in those with low-grade disease (6/59, 10%). Overall 5-year survival was 66%. Five-year survival rate for those with high-grade sarcomas (49%) was significantly lower than that for low-grade sarcomas (90%, p less than 0.0001). Tumor size and age of patient were not prognostic.
Survival of patients with primary soft tissue sarcomas of the chest wall after resection is similar to that of patients with sarcomas of the extremities. Resection alone provides acceptable survival (90% at 5 years) for those with low-grade sarcomas, but adjuvant treatment should be considered for those with high-grade sarcomas.
胸壁原发性软组织肉瘤并不常见，有关治疗及结果的数据稀少。多数研究将这些肿瘤归类为躯干肉瘤，并推断预后不良。为评估手术治疗的结果，我们回顾了40年的经验。
回顾了1948年至1988年我院收治的189例患者的记录。本报告涵盖的149例（79%）患者有病理资料可供查阅。采用Kaplan-Meier法计算生存率，通过对数秩分析进行比较，显著性定义为p小于0.05。
年龄范围为3周至86岁（中位数为38岁）；男女患者比例为2:1。97%的病例最初症状为肿块或疼痛。90例（60%）肉瘤为高级别，59例（40%）为低级别。组织学类型如下：硬纤维瘤（n = 32，21%）；脂肪肉瘤（n = 23，15%）；横纹肌肉瘤（n = 18，12%）；纤维肉瘤（n = 17，11%）；胚胎性横纹肌肉瘤（n = 14，9%）；恶性外周神经鞘瘤（n = 13，9%）；恶性纤维组织细胞瘤（n = 11，7%）；梭形细胞肉瘤（n = 4，3%）；滑膜肉瘤（n = 3，3%）；血管外皮细胞瘤（n = 3，3%）；腺泡状软组织肉瘤（n = 3，3%）；以及其他类型（n = 12，9%）。140例（94%）的主要治疗方式为手术切除。27%出现局部复发。52例（35%）发生转移（异时性转移42例，同时性转移10例），高级别疾病患者中转移更常见（46/90，51%），而低级别疾病患者中转移较少（6/59，10%）。总体5年生存率为66%。高级别肉瘤患者的5年生存率（49%）显著低于低级别肉瘤患者（90%，p小于0.0001）。肿瘤大小和患者年龄并非预后因素。
胸壁原发性软组织肉瘤患者术后生存率与肢体肉瘤患者相似。对于低级别肉瘤患者，单纯手术切除可提供可接受的生存率（5年时为90%），但对于高级别肉瘤患者应考虑辅助治疗。
