Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8774, USA.
Acta Oncol. 2013 May;52(4):793-802. doi: 10.3109/0284186X.2012.711953. Epub 2012 Aug 9.
Limb salvage surgery (LSS) has gained widespread acceptance as the current treatment for treating extremity soft tissue sarcoma (STS) and has been greatly refined since its inception. Combined with improved adjuvant treatment modalities, rates of local relapse have greatly decreased. Nonetheless, local recurrence still occurs and identifying the cause and the subsequent effects of local recurrence can provide valuable insights as LSS continues to evolve.
This retrospective study evaluated 278 patients treated for STS of the extremities between 2000 and 2006. Of these, 41 patients developed a local recurrence while 247 did not. Tumor characteristics and prognostic outcomes were analyzed. Wilcoxon rank sum test and either χ(2) or Fisher's exact was used to compare variables. Kaplan Meier and Gray's test for cumulative risk were also performed.
Patients who had a positive margin were 3.76 times more likely to develop local recurrence when compared to those with negative margins. This corresponds to a 38% risk of local recurrence if the margins were positive after six years vs. 12% if the margins were negative. In patients who underwent a re-excision, the presence or absence of residual disease upon re-excision did not have any bearing on local recurrence (p = 0.27). In comparing patients with and without local recurrence, there was no statistically significant difference in the rate and the proportion encountering distant metastasis and death due to sarcoma (p > 0.05).
Despite advancements in surgery, radiation and imaging, positive margins still occur, and the presence of positive margins following definitive treatment continues to remain as a strong predictor for local recurrence. While local recurrence represents a negative outcome for a patient, its impact on future prognosis is influenced by a variety of factors such as time to local recurrence as well as the tumor's inherent biological characteristics.
肢体保全手术（LSS）作为治疗肢体软组织肉瘤（STS）的当前治疗方法已被广泛接受，并且自成立以来已经得到了极大的改进。结合改进的辅助治疗方式，局部复发率大大降低。尽管如此，局部复发仍时有发生，确定局部复发的原因及其后续影响，可以为 LSS 的不断发展提供有价值的见解。
本回顾性研究评估了 2000 年至 2006 年间接受肢体 STS 治疗的 278 名患者。其中 41 名患者发生局部复发，247 名患者未发生局部复发。分析了肿瘤特征和预后结果。Wilcoxon 秩和检验和 χ(2)或 Fisher 确切检验用于比较变量。Kaplan-Meier 和 Gray 累积风险检验也进行了。
与切缘阴性的患者相比，切缘阳性的患者发生局部复发的可能性高 3.76 倍。这对应于六年时切缘阳性患者局部复发的风险为 38%，而切缘阴性患者为 12%。在接受再次切除的患者中，再次切除时残留疾病的存在与否与局部复发无关（p = 0.27）。在比较有和无局部复发的患者时，远处转移和因肉瘤死亡的发生率和比例在统计学上没有显著差异（p > 0.05）。
尽管手术、放疗和影像学技术有所进步，但仍存在切缘阳性的情况，明确治疗后存在切缘阳性仍然是局部复发的强烈预测因素。尽管局部复发对患者的预后产生负面影响，但它对未来预后的影响受到多种因素的影响，例如局部复发的时间以及肿瘤的固有生物学特征。
