Li Yuan, Niu Xiao-hui, Xu Hai-rong
Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing 100045, China.
Zhonghua Wai Ke Za Zhi. 2011 Nov;49(11):964-9.
To investigate the prognosis factors of soft tissue sarcoma, especially the impact of surgical treatment on the prognosis.
We retrospectively reviewed 208 surgically treated patients. There were 128 male and 80 female. The average age was 46 ranged from 9 to 98 years old. Possible factors of whether the patient firstly treated in our hospital, the tumor size (< 5 cm, 5 ∼ 10 cm, > 10 cm), tumor depth (superficial deep fascia, under the deep fascia), histological type (such as adipose sarcoma, malignant fibrous histiocytoma, synovial sarcoma, fibrous sarcoma, malignant peripheral nerve sheath tumors, other tumors), tumor grade (FNCLCC I, II, III), surgical margin (intralesional, marginal, wide, radical) and adjuvant therapy on the prognosis of patients were analyzed.
The median follow-up was 37.5 ranged from 1.3 to 128.1 months. The overall 3-year and 5-year survival were 77% and 75%. The overall 3-year and 5-year recurrence rate were 28% and 37%. The overall 3-year and 5-year metastasis rate were 35% and 43%. Tumor size, tumor grade and metastasis or not independently affected survival (χ(2) = 18.813, 24.849 and 21.107, all P < 0.05). Whether the patient firstly treated in our hospital and histological type independently affect the local recurrence (χ(2) = 21.915, 12.192, both P < 0.05); histological grade can independently affect the metastasis (χ(2) = 7.714, P < 0.05). Surgical margin alone affected the local recurrence and metastasis (χ(2) = 19.610, 9.272, both P < 0.05).
Surgical margin independently affected local recurrence and distant metastasis, and thus indirectly affect the survival of soft tissue sarcoma. In particular, the primary choice for treatment of soft tissue sarcoma without metastasis should be surgery. Wide or radical margin could significantly improve the prognosis of soft tissue sarcoma patients.
探讨软组织肉瘤的预后因素，尤其是手术治疗对预后的影响。
回顾性分析208例接受手术治疗的患者。其中男性128例，女性80例。平均年龄46岁，年龄范围为9至98岁。分析可能影响患者预后的因素，包括是否首次在我院治疗、肿瘤大小（<5 cm、5～10 cm、>10 cm）、肿瘤深度（浅筋膜浅层、深筋膜深层）、组织学类型（如脂肪肉瘤、恶性纤维组织细胞瘤、滑膜肉瘤、纤维肉瘤、恶性外周神经鞘瘤、其他肿瘤）、肿瘤分级（法国国立癌症中心联合会分级I、II、III级）、手术切缘（囊内、边缘、广泛、根治性）及辅助治疗。
中位随访时间为37.5个月，范围为1.3至128.1个月。3年和5年总生存率分别为77%和75%。3年和5年总复发率分别为28%和37%。3年和5年总转移率分别为35%和43%。肿瘤大小、肿瘤分级及是否发生转移独立影响生存率（χ² = 18.813、24.849和21.107，P均<0.05）。患者是否首次在我院治疗及组织学类型独立影响局部复发（χ² = 21.915、12.192，P均<0.05）；组织学分级可独立影响转移（χ² = 7.714，P<0.05）。单纯手术切缘影响局部复发和转移（χ² = 19.610、9.272，P均<0.05）。
手术切缘独立影响局部复发和远处转移，从而间接影响软组织肉瘤患者的生存。特别是对于无转移的软组织肉瘤，首选治疗方法应为手术。广泛或根治性切缘可显著改善软组织肉瘤患者的预后。
