Farhood A I, Hajdu S I, Shiu M H, Strong E W
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Am J Surg. 1990 Oct;160(4):365-9. doi: 10.1016/s0002-9610(05)80544-6.
We reviewed the clinical records and pathologic material of 176 adults with primary soft tissue sarcomas treated at Memorial Sloan-Kettering Cancer Center between 1950 and 1985. Seventy-two patients (41%) had low-grade sarcomas and 104 (59%) had high-grade sarcomas. All but 18 patients underwent some form of excision as initial therapy. Adjuvant radiotherapy and chemotherapy combined with surgical excision showed no significant effect. A significantly increased risk of treatment failure was associated with large tumor size, positive surgical margins, bone involvement, local recurrence, metastatic spread, and high histologic grade. Except for recurrence, the p value by univariate analysis in the log-rank test for comparison of survival according to these clinical and pathologic characteristics was p less than 0.0001. Although the overall survival was 75% at 2 years, 55% at 5 years, and 46% at 10 years, only 20% of the patients with high-grade sarcomas were alive 10 years after treatment. Most patients with rhabdomyosarcoma, high-grade peripheral nerve tumor, and high-grade fibrous histiocytoma and all patients with high-grade angiosarcoma died of disease less than 5 years after diagnosis. New therapeutic strategies are needed to improve the survival of adult patients with high-grade soft tissue sarcomas of the head and neck.
我们回顾了1950年至1985年间在纪念斯隆凯特琳癌症中心接受治疗的176例原发性软组织肉瘤成年患者的临床记录和病理资料。72例患者（41%）患有低级别肉瘤，104例（59%）患有高级别肉瘤。除18例患者外，所有患者均接受了某种形式的切除作为初始治疗。辅助放疗和化疗联合手术切除未显示出显著效果。治疗失败风险显著增加与肿瘤体积大、手术切缘阳性、骨受累、局部复发、转移扩散和高组织学分级相关。除复发外，根据这些临床和病理特征比较生存情况的对数秩检验单因素分析的p值小于0.0001。尽管2年总生存率为75%，5年为55%，10年为46%，但高级别肉瘤患者中只有20%在治疗后10年仍存活。大多数横纹肌肉瘤、高级别周围神经肿瘤和高级别纤维组织细胞瘤患者以及所有高级别血管肉瘤患者在诊断后不到5年死于疾病。需要新的治疗策略来提高头颈部高级别软组织肉瘤成年患者的生存率。
