Friedmann Daniel, Wunder Jay S, Ferguson Peter, O'Sullivan Brian, Roberge David, Catton Charles, Freeman Carolyn, Saran Neil, Turcotte Robert E
Division of Orthopedic Surgery, McGill University Health Centre, Montreal, QC, Canada H3G 1A4.
Sarcoma. 2011;2011:289673. doi: 10.1155/2011/289673. Epub 2011 Nov 20.
Background and Purpose. Lymphoedema is a serious complication following limb salvage for extremity soft tissue sarcomas (STSs) for which little is known. We aimed to evaluate its incidence, its, severity and its associated risk factors. Material and Method. Patient and tumor characteristics, treatment modalities and complications and functional outcomes (MSTS 1987, TESS), and lymphoedema severity (Stern) were all collected from prospective databases. Charts were retrospectively abstracted for BMI and comorbidities. Results. There were 289 patients (158 males). Mean age was 53 (16-88). Followup ranged between 12 and 60 months with an average of 35 and a median of 36 months. Mean BMI was 27.4 (15.8-52.1). 72% had lower extremity tumors and 38% upper extremity. Mean tumor size was 8.1 cm (1.0-35.6 cm). 27% had no adjuvant radiation, 62% had 50 Gy, and 11% received 66 Gy. The incidence of lymphoedema was 28.8% (206 none, 58 mild, 22 moderate, 3 severe, and 0 very severe). Mean MSTS score was 32 (11-35) and TESS was 89.4 (32.4-100). Radiation dose was significantly correlated with tumor size > 5 cm (P = 0.0001) and TESS score (P = 0.001), but not MSTS score (P = 0.090). Only tumor size > 5 cm and depth were found to be independent predictors of significant lymphoedema. Conclusion. Nine percent of STS patients in our cohort developed significant (grade ≥ 2) lymphoedema. Tumor size > 5 cm and deep tumors were associated with an increased occurrence of lymphoedema but not radiation dosage.
背景与目的。淋巴水肿是肢体软组织肉瘤（STS）保肢术后的一种严重并发症，对此了解甚少。我们旨在评估其发生率、严重程度及相关危险因素。材料与方法。从前瞻性数据库中收集患者及肿瘤特征、治疗方式、并发症和功能结局（MSTS 1987，TESS）以及淋巴水肿严重程度（斯特恩分级）。回顾性提取病历以获取体重指数（BMI）和合并症信息。结果。共有289例患者（158例男性）。平均年龄为53岁（16 - 88岁）。随访时间为12至60个月，平均35个月，中位数为36个月。平均BMI为27.4（15.8 - 52.1）。72%的患者肿瘤位于下肢，38%位于上肢。平均肿瘤大小为8.1厘米（1.0 - 35.6厘米）。27%的患者未接受辅助放疗，62%接受50 Gy，11%接受66 Gy。淋巴水肿的发生率为28.8%（206例无水肿，58例轻度，22例中度，3例重度，0例极重度）。平均MSTS评分为32（11 - 35），TESS评分为89.4（32.4 - 100）。放疗剂量与肿瘤大小>5厘米（P = 0.0001）及TESS评分（P = 0.001）显著相关，但与MSTS评分无关（P = 0.090）。仅发现肿瘤大小>5厘米和肿瘤深度是显著淋巴水肿的独立预测因素。结论。我们队列中9%的STS患者发生了严重（≥2级）淋巴水肿。肿瘤大小>5厘米和深部肿瘤与淋巴水肿发生率增加相关，但与放疗剂量无关。
