Clinique chirurgicale orthopédique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
Orthop Traumatol Surg Res. 2012 Jun;98(4 Suppl):S9-18. doi: 10.1016/j.otsr.2012.04.006. Epub 2012 May 15.
Resection margins constitute a recognized risk factor for local recurrence, but their impact on survival is less clear.
Infiltrative proliferation and satellite nodules are prognostic factors for local and systemic aggressiveness.
Retrospective cohort study.
In 105 patients under curative treatment, resection quality was assessed on UICC criteria (R0/R1) and on a modified version (R0M/R1M) taking account of proliferation contours and satellite nodules for narrow margins (<1mm). Uni- and multi-variate analysis was performed, and Kaplan-Meier survival curves were compared on log-rank.
Mean 5-year local recurrence-free survival (LRFS) was 0.64 [0.52-0.76] after R1 surgery, 0.9 [0.85-0.95] after R0, 0.64 [0.519-0.751] after R1M and 0.92 [0.87-0.96] after R0M. Resection type according to R classification correlated with disease-free survival (DFS) (P=0.028), but not with metastasis-free survival (MFS) (P=0.156). Resection type according to RM classification correlated with DFS and MFS. Multivariate analysis disclosed correlations between LRFS rate and RM resection type (HR 6.77 [1.78-25.7], P=0.005), DFS rate and RM resection type (HR 2.83 [1.47-5.43], P=0.001) and grade (HR=3.17 [1.38-7.27], P=0.003), and MFS and grade (HR=3.96 [1.50-10.5], P=0.006).
The microscopic aspect of the proliferation contours and presence of satellite nodules were confirmed as prognostic factors for local and systemic aggressiveness. They impact both disease-free survival and metastasis-free survival in case of margins less than 1mm. Their systematic consideration may help identify patients with elevated systemic risk.
IV.
切除边缘是局部复发的公认危险因素，但它们对生存的影响尚不清楚。
浸润性增殖和卫星结节是局部和全身侵袭性的预后因素。
回顾性队列研究。
在 105 例接受根治性治疗的患者中，根据 UICC 标准（R0/R1）和改良版本（考虑到狭窄边缘（<1mm）的增殖轮廓和卫星结节）评估切除质量（R0M/R1M）。进行单变量和多变量分析，并在对数秩检验上比较 Kaplan-Meier 生存曲线。
R1 手术后的 5 年局部无复发生存率（LRFS）为 0.64 [0.52-0.76]，R0 手术后为 0.9 [0.85-0.95]，R1M 手术后为 0.64 [0.519-0.751]，R0M 手术后为 0.92 [0.87-0.96]。根据 R 分类的切除类型与无病生存（DFS）相关（P=0.028），但与无转移生存（MFS）无关（P=0.156）。根据 RM 分类的切除类型与 DFS 和 MFS 相关。多变量分析显示，LRFS 率与 RM 切除类型（HR 6.77 [1.78-25.7]，P=0.005）、DFS 率与 RM 切除类型（HR 2.83 [1.47-5.43]，P=0.001）和分级（HR=3.17 [1.38-7.27]，P=0.003）以及 MFS 和分级（HR=3.96 [1.50-10.5]，P=0.006）相关。
增殖轮廓的微观外观和卫星结节的存在被证实是局部和全身侵袭性的预后因素。它们在边缘小于 1mm 的情况下，既影响无病生存，也影响无转移生存。系统考虑这些因素可能有助于识别系统风险升高的患者。
IV。
