Department of Hepatobiliary and Transplantation Surgery, Liver Unit, Queen Elizabeth Hospital, University Hospital of Birmingham NHS Foundation Trust, Birmingham, UK.
Eur J Surg Oncol. 2011 Jan;37(1):87-92. doi: 10.1016/j.ejso.2010.11.006.
The aim of this retrospective study was to analyse the outcome following hepatic resection for metastatic STS and to identify factors predicting survival.
All patients who underwent hepatic resection for metastatic STS between August 1997 and April 2009 were included. The data was obtained from a prospectively maintained database. Patients' demographics, clinico-pathological parameters, overall survival and the factors predicting survival were analysed.
Thirty-six patients underwent hepatic resection for metastasis, with a median age of 58 years. The predominant site of primary tumour was the gastro-intestinal tract (50%). Leiomyosarcoma was the most common histological type (54%). The median interval between the primary and metastatic resections was 17 months. Thirteen patients had synchronous tumours. 24 patients had major liver resections and 10 patients had bi-lobar disease. The median number of liver lesions resected was 1(1-6) and the median maximum diameter was 11 cm (1-26 cm). R0 resection was performed in 31 patients. The 1-, 3- and 5-year overall survival from the time of metastasectomy was 90.3%, 48.0% and 31.8% respectively, with a median survival of 24 months. Factors associated with poor survival on univariate analysis were the presence of high grade tumours (p = 0.04), primary leiomyosarcoma (p = 0.01) and positive resection margin of liver metastasis (p = 0.04), whilst multivariate analysis predicted primary leiomyosarcoma as a risk factor for poor survival (p = 0.01).
Hepatic resection for metastatic STS appears to be valuable in carefully selected patients with acceptable long-term survival. The aim of surgery must be an R0 resection to offer a chance of cure.
本回顾性研究旨在分析肝转移去分化脂肪肉瘤（STS）患者接受肝切除术的治疗效果，并确定预测患者生存的因素。
纳入 1997 年 8 月至 2009 年 4 月期间接受肝转移去分化脂肪肉瘤切除术的所有患者。数据来自前瞻性维护的数据库。分析患者的人口统计学、临床病理参数、总生存率和预测生存率的因素。
36 例患者接受了肝转移切除术，中位年龄为 58 岁。主要原发肿瘤部位为胃肠道（50%）。最常见的组织学类型是平滑肌肉瘤（54%）。原发肿瘤和转移瘤切除的中位间隔时间为 17 个月。13 例患者为同步肿瘤。24 例患者接受了主要肝切除术，10 例患者为双叶病变。切除的肝转移灶中位数为 1（1-6）个，最大直径中位数为 11cm（1-26cm）。31 例患者达到了 R0 切除。从转移切除术开始的 1、3 和 5 年总生存率分别为 90.3%、48.0%和 31.8%，中位生存时间为 24 个月。单因素分析中，与生存不良相关的因素包括高级别肿瘤（p=0.04）、原发平滑肌肉瘤（p=0.01）和肝转移灶切缘阳性（p=0.04），而多因素分析预测原发平滑肌肉瘤是生存不良的危险因素（p=0.01）。
在仔细选择的患者中，肝转移去分化脂肪肉瘤切除术似乎具有价值，可获得可接受的长期生存。手术的目的必须是 R0 切除，以提供治愈的机会。
