Department of Medical Oncology, Bergonie Institute, Bordeaux, France.
Cancer. 2011 Mar 1;117(5):1049-54. doi: 10.1002/cncr.25538. Epub 2010 Oct 13.
The objective of this study was to determine whether the overall survival of patients with metastatic soft tissue sarcoma (STS) has improved over the last 20 years.
In total, 1024 patients who had synchronous metastatic (SM) STS or metachronous metastatic (MM) STS diagnosed between 1987 and 2006 were included prospectively in the French Sarcoma Group database after central histologic review. Four periods of diagnosis of metastatic disease were defined: P1, from 1987 to 1991 (n = 208); P2, from 1992 to 1996 (n = 287); P3, from 1997 to 2001 (n = 285); and P4, from 2002 to 2006 (n = 244). Patient characteristics were analyzed as prognostic factors by using a Cox model.
The proportion of patients with SM, the interval between diagnosis and MM, and the clinical characteristics of the patients were similar across the 4 periods. Although there was no significant difference in the median overall survival (OS) from P1 through P2 (P1, 12.3 months; 95% confidence interval [CI], 9.9-14.7 months; P2, 11.4 months; 95% CI, 9-13.9 months), significant improvements were observed in the later periods (P3, 15 months; 95% CI, 11.8-18.2 months; P4, 18 months; 95% CI, 15.3-20.7 months; P = .029; log-rank test). The 2-year OS rate also increased throughout the study period from 28.1% during P1 to 38.7% during P4. On multivariate analysis, period of diagnosis, age, histologic subtype, time to metastatic recurrence, French Federation of Cancer Centers Sarcoma Group grade, and the number of metastatic sites were independent prognostic factors for OS.
The current analysis revealed that the median OS of patients with metastatic STS had improved by 50% during the last 20 years. These data should be considered in the interpretation of results from ongoing and future STS trials.
本研究旨在确定转移性软组织肉瘤（STS）患者的总体生存率是否在过去 20 年中有所提高。
1987 年至 2006 年间，前瞻性地将法国肉瘤组数据库中经中心组织学审查诊断为同步转移性（SM）STS 或异时转移性（MM）STS 的 1024 名患者纳入研究。将转移性疾病的诊断分为四个时期：P1 期为 1987 年至 1991 年（n = 208）；P2 期为 1992 年至 1996 年（n = 287）；P3 期为 1997 年至 2001 年（n = 285）；P4 期为 2002 年至 2006 年（n = 244）。使用 Cox 模型分析患者特征作为预后因素。
四个时期患者中 SM 的比例、诊断与 MM 之间的间隔以及患者的临床特征相似。尽管 P1 至 P2 期间的中位总生存期（OS）无显著差异（P1 为 12.3 个月；95%置信区间[CI]，9.9-14.7 个月；P2 为 11.4 个月；95%CI，9-13.9 个月），但在后期观察到了显著的改善（P3 为 15 个月；95%CI，11.8-18.2 个月；P4 为 18 个月；95%CI，15.3-20.7 个月；P =.029；对数秩检验）。在整个研究期间，2 年 OS 率也从 P1 期间的 28.1%增加到 P4 期间的 38.7%。多变量分析显示，诊断期、年龄、组织学亚型、转移复发时间、法国癌症中心肉瘤组分级和转移部位数量是 OS 的独立预后因素。
目前的分析显示，过去 20 年转移性 STS 患者的中位 OS 提高了 50%。在解释正在进行和未来的 STS 试验的结果时，应考虑这些数据。
