Department of Orthopaedic Surgery, Cancer Institute Hospital for Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, 135-8550 Tokyo, Japan.
Clin Orthop Relat Res. 2012 Mar;470(3):700-5. doi: 10.1007/s11999-011-2017-5.
Patients with local recurrence of soft-tissue sarcomas have a poor overall survival. High-grade, soft-tissue sarcomas in deep locations may have a poorer prognosis regarding local recurrence than low-grade sarcomas or those located superficially. Although previous reports evaluated tumors at various depths, it is unclear what factors influence recurrence of deep, high-grade sarcomas.
QUESTIONS/PURPOSES: We therefore determined whether possible risk factors (tumor size, location, histologic subtype, unplanned excision, local recurrence at presentation, metastasis at diagnosis, surgical procedure, surgical margin, and adjuvant treatments) influenced local recurrence of deep, high-grade, soft-tissue sarcomas.
We retrospectively reviewed 433 patients with deep, high-grade, soft-tissue sarcomas surgically treated between 1985 and 2005. For each patient, we reviewed tumor size, location, histologic subtype, unplanned excision, local recurrence at presentation, metastasis at diagnosis, surgical procedure, surgical margin, and adjuvant treatments and determined the effect of each prognostic variable on local recurrence. The minimum followup was 1 month (median, 51 months; range, 1-305 months).
Forty-seven patients had local recurrence at a median of 10.7 months. Local recurrence at presentation, metastasis at diagnosis, and positive margins independently predicted local recurrence. No other factors independently predicted local recurrence.
Unplanned excisions did not increase the rate of local recurrence of deep, high-grade, soft-tissue sarcomas if treated appropriately. Aggressiveness of tumor represented by metastasis or local recurrence at presentation may be a risk for local recurrence.
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
软组织肉瘤局部复发患者的总体生存率较差。位于深部、高级别的软组织肉瘤相较于低级别的肉瘤或位于浅表部位的肉瘤，其局部复发的预后可能更差。尽管之前的报告评估了不同深度的肿瘤，但目前尚不清楚哪些因素会影响深部高级别肉瘤的复发。
问题/目的：因此，我们确定了是否存在可能的风险因素（肿瘤大小、位置、组织学亚型、计划外切除、初次就诊时的局部复发、诊断时的转移、手术过程、手术切缘和辅助治疗）会影响深部高级别软组织肉瘤的局部复发。
我们回顾性分析了 1985 年至 2005 年期间接受手术治疗的 433 例深部高级别软组织肉瘤患者。对于每位患者，我们回顾了肿瘤大小、位置、组织学亚型、计划外切除、初次就诊时的局部复发、诊断时的转移、手术过程、手术切缘和辅助治疗，并确定了每个预后因素对局部复发的影响。最小随访时间为 1 个月（中位数，51 个月；范围，1-305 个月）。
47 例患者在中位时间 10.7 个月时出现局部复发。初次就诊时的局部复发、诊断时的转移和阳性切缘独立预测了局部复发。没有其他因素独立预测局部复发。
如果处理得当，计划外切除不会增加深部高级别软组织肉瘤局部复发的发生率。以转移或初次就诊时的局部复发为代表的肿瘤侵袭性可能是局部复发的风险因素。
Ⅱ级，预后研究。有关证据水平的完整描述，请参见作者指南。
