Musculoskeletal Oncology, Mayo Clinic, Rochester, MN, USA.
Clin Orthop Relat Res. 2010 Nov;468(11):3003-11. doi: 10.1007/s11999-010-1471-9.
Established prognostic factors influencing survival in soft tissue sarcomas include tumor stage, histopathologic grade, size, depth, and anatomic site. The presence of tumor near or at the margin of resection increases the risk of local recurrence but whether a positive surgical margin or local recurrence affect overall survival is controversial.
QUESTIONS/PURPOSES: We explored the impact of microscopic margin on local recurrence, metastasis, and overall survival in patients with intermediate- to high-grade soft tissue sarcomas of the extremities. We then determined whether local recurrence decreases overall survival.
We retrospectively reviewed the medical records of 248 patients who had soft tissue sarcomas of the extremities treated surgically from 1995 to 2008. We estimated survival, local recurrence, and distant metastasis and examined factors potentially influencing these outcomes. The minimum followup was 0.4 years (median, 4.4 years; range, 0.4-13 years).
The 5-year cumulative incidence of local recurrence was 4.1%. Patients who presented with positive margins or a margin of 2 mm or less had a worse survival than patients who had margins of greater than 2 mm and wide margins (5-year survival, 47% versus 70% and 72%). In addition to surgical margin, developing metastasis, tumor response of less than 90% necrosis, high histopathologic grade, high AJCC stage (Stage III), increasing age, and male gender were associated with decreased overall survival. Local recurrence independently predicted decreased overall survival.
Microscopic surgical margin and local recurrence after surgical treatment should be included as risk factors predicting decreased overall survival for intermediate- to high-grade soft tissue sarcomas of the extremities.
影响软组织肉瘤生存的既定预后因素包括肿瘤分期、组织病理学分级、大小、深度和解剖部位。肿瘤位于或靠近切除边缘会增加局部复发的风险，但手术切缘阳性或局部复发是否影响总生存仍存在争议。
问题/目的：我们探讨了肢体中高级别软组织肉瘤患者的显微镜下切缘对局部复发、转移和总生存的影响。然后，我们确定了局部复发是否会降低总生存率。
我们回顾性分析了 1995 年至 2008 年接受手术治疗的 248 例肢体软组织肉瘤患者的病历。我们估计了生存、局部复发和远处转移，并检查了可能影响这些结果的因素。最小随访时间为 0.4 年（中位数为 4.4 年；范围为 0.4-13 年）。
5 年局部复发累积发生率为 4.1%。切缘阳性或切缘为 2mm 或更小时，患者的生存状况较差，而切缘大于 2mm 且切缘宽的患者生存状况较好（5 年生存率分别为 47%、70%和 72%）。除了手术切缘，发生转移、肿瘤坏死小于 90%、组织病理学分级高、AJCC 分期（III 期）高、年龄增加和男性也是总生存降低的相关因素。局部复发是独立预测总生存降低的因素。
肢体中高级别软组织肉瘤的显微镜下手术切缘和手术后局部复发应作为预测总生存降低的危险因素。
