University of Michigan Medical School, Ann Arbor, USA.
Am J Clin Oncol. 2012 Apr;35(2):151-7. doi: 10.1097/COC.0b013e318209cd72.
We reviewed our institution's experience in treating soft tissue sarcomas of the extremity to identify factors associated with local recurrence, metastasis, and overall survival, to identify patients who may benefit from intensification of therapy.
A retrospective analysis was performed for patients who underwent both limb-sparing surgery and external beam radiotherapy for extremity sarcoma. Those who had gross residual disease or who presented with recurrent or metastatic disease were excluded. The Kaplan-Meier product limit and multivariate Cox regression were used to estimate local failure-free probability, distant failure-free probability, and overall survival along with associations with patient, tumor, and treatment characteristics.
One hundred eighty-eight patients were included in the analysis. Twenty-five (13%) and 46 (24%) experienced local and distant recurrence, respectively. Patients with high/intermediate-grade tumors [hazard ratio (HR)=5.63, 95% confidence interval (CI): 1.27-24.89, P=0.023] or with multifocally positive margins (HR=4.27, 95% CI: 1.20-15.24, P=0.026) were more likely to fail locally. Those with a preceding local recurrence (HR=8.58, 95% CI: 3.87-19.04, P<0.0001), high/intermediate-grade tumors (HR=5.68, 95% CI: 1.28-25.25, P=0.023), or no secondary reexcision (HR=2.5, 95% CI: 1.09-5.74, P=0.031) were more likely to develop metastasis. Patients with local recurrence (HR=3.6, 95% CI: 1.77-7.29, P<0.001), metastasis (HR=16.0, 95% CI: 7.93-32.31, P<0.0001), or without secondary reexcision (HR=3.2, 95% CI: 1.27-8.09, P=0.014) had decreased overall survival.
Patients whose tumor grade or margin status put them at high risk for local failure should be considered for intensification of therapy. Those with a local recurrence should be considered for increased surveillance or systemic therapy, as local failure is associated with subsequent metastasis and decreased survival.
我们回顾了本机构治疗肢体软组织肉瘤的经验，以确定与局部复发、转移和总生存相关的因素，确定可能从治疗强化中获益的患者。
对接受保肢手术和外部束放疗的肢体肉瘤患者进行回顾性分析。排除有明显残留疾病或出现复发或转移疾病的患者。采用Kaplan-Meier 乘积限和多变量 Cox 回归来估计局部无失败概率、远处无失败概率和总生存率，并与患者、肿瘤和治疗特征相关联。
188 例患者纳入分析。25 例（13%）和 46 例（24%）患者分别出现局部和远处复发。高级/中等级别肿瘤患者[风险比（HR）=5.63，95%置信区间（CI）：1.27-24.89，P=0.023]或多灶性阳性切缘患者（HR=4.27，95%CI：1.20-15.24，P=0.026）更有可能发生局部失败。先前发生局部复发患者（HR=8.58，95%CI：3.87-19.04，P<0.0001）、高级/中等级别肿瘤患者（HR=5.68，95%CI：1.28-25.25，P=0.023）或无二次切除患者（HR=2.5，95%CI：1.09-5.74，P=0.031）更有可能发生转移。出现局部复发患者（HR=3.6，95%CI：1.77-7.29，P<0.001）、转移患者（HR=16.0，95%CI：7.93-32.31，P<0.0001）或无二次切除患者（HR=3.2，95%CI：1.27-8.09，P=0.014）的总生存率降低。
肿瘤分级或切缘状态提示局部复发风险高的患者应考虑强化治疗。出现局部复发的患者应考虑增加监测或全身治疗，因为局部复发与随后的转移和生存率降低相关。
