Department of Surgery, Division of Cardiac and Thoracic Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
J Thorac Oncol. 2012 Mar;7(3):552-8. doi: 10.1097/JTO.0b013e31824176df.
Primary chest wall sarcomas are rare mesenchymal tumors and their mainstay of therapy is wide surgical resection. We report our single-institution, multidisciplinary experience with full-thickness resection for primary chest wall sarcomas.
A retrospective review of our prospectively maintained databases revealed that 51 patients were referred for primary chest wall sarcomas from 1990 to 2009.
All patients required resections that included rib and/or sternum. Twenty-nine patients (57%) had extended resections beyond the chest wall. Forty-two patients (82%) required prosthetic reconstruction and 17 patients (33%) had muscle flap coverage. Overall, 51% (26/51) of patients received neoadjuvant therapy. Seventy-three percent (11/15) of high-grade soft tissue sarcomas, 77% (10/13) of high-risk bony sarcomas, and 67% (4/6) of desmoid tumors were treated with induction therapy. Negative margins were obtained in 46 patients (90%). There were no perioperative mortalities. Eight patients (16%) experienced complications. Local recurrence and metastasis was detected in 14 and 23%. Five-year overall and disease-free survivals were 66% and 47%, respectively. Favorable prognostic variables for survival included age ≤50 years, tumor volume ≤200 cm, desmoid tumor, bony tumor, chondrosarcoma, and low-grade soft tissue sarcoma.
We report our multidisciplinary experience with primary chest wall sarcomas that included induction therapy in the majority of high-risk soft tissue and bony sarcomas and desmoid tumors. Despite aggressive preoperative treatments, acceptable surgical results with low morbidity and mortality can be achieved. Neoadjuvant systemic therapy may reduce local and distant recurrence and improve overall survival.
原发性胸壁肉瘤是罕见的间叶组织肿瘤，其主要治疗方法是广泛的手术切除。我们报告了我们单一机构的多学科经验，即对原发性胸壁肉瘤进行全层切除术。
对我们前瞻性维护的数据库进行回顾性分析，显示 1990 年至 2009 年期间有 51 例患者因原发性胸壁肉瘤就诊。
所有患者均需进行包括肋骨和/或胸骨在内的切除术。29 例（57%）患者进行了超出胸壁范围的广泛切除术。42 例（82%）患者需要假体重建，17 例（33%）患者需要肌肉瓣覆盖。总体而言，51%（26/51）的患者接受了新辅助治疗。15 例高级别软组织肉瘤中有 73%（11/15）、13 例高危骨肉瘤中有 77%（10/13）、6 例纤维瘤病中有 67%（4/6）接受了诱导治疗。46 例（90%）患者获得了阴性切缘。无围手术期死亡。8 例（16%）患者发生并发症。14 例患者出现局部复发，23 例患者出现转移。5 年总生存率和无病生存率分别为 66%和 47%。生存的有利预后因素包括年龄≤50 岁、肿瘤体积≤200cm、纤维瘤病、骨肿瘤、软骨肉瘤和低级别软组织肉瘤。
我们报告了我们的多学科经验，包括对大多数高危软组织和骨肉瘤和纤维瘤病进行诱导治疗。尽管进行了积极的术前治疗，但仍能获得可接受的手术结果，且发病率和死亡率较低。新辅助全身治疗可能降低局部和远处复发率，提高总生存率。
