Orthopaedic Surgery Department, Aga Khan University Hospital, Karachi 74800, Pakistan.
World J Surg Oncol. 2012 Sep 13;10:188. doi: 10.1186/1477-7819-10-188.
Managing soft tissue sarcomas (STS) in a developing country with limited financial resources and a poor health referral system is a challenge. Presenting late, these extremity STS are prone to recurrence despite apparently complete resection. This study aimed to explore and compare the impact of clinico-pathological factors on recurrence and survival in Pakistan with the corresponding figures quoted from the developed world.
An institutional review was performed on all patients with primary STS of the extremities operated on between 1994 and 2008. The prognostic influence of clinical, pathologic, and treatment variables on local recurrence free survival (LRFS), metastasis free survival (MFS) and overall survival (OS) were analyzed by univariate and multivariate Cox regression analysis and Kaplan Meier survival curves.
A total of 84 patients with a mean age of 41.8 ± 21.9 years were included in the study. The local recurrence rate was 14.3% after a median of 6 (mean 7.4) months. Metastases occurred in 7 patients (8.3%) and 65 patients were alive without evidence of disease after a mean follow-up of 52.6 ± 39.8 months. Tumor size > 5 cm, grade 3 tumors and margin < 10 mm significantly increased local recurrence rates. A margin ≥ 10 mm and age < 45 years significantly enhanced cumulative survival. Significant multivariate risk factors for metastases were margin < 10 mm and tumor grade G3.
Despite a poor health referral system in our country, our results are no different from those reported from the developed world. Surgical margins and tumor grade prognostically influenced LRFS, MFS and OS.
在一个财政资源有限且医疗转诊系统不完善的发展中国家管理软组织肉瘤（STS）是一项挑战。这些发生在四肢的晚期 STS 尽管看起来完全切除，但仍容易复发。本研究旨在探讨和比较临床病理因素对复发和生存的影响，并与来自发达国家的相应数据进行比较。
对 1994 年至 2008 年间在我院接受手术治疗的原发性四肢 STS 患者进行机构审查。采用单变量和多变量 Cox 回归分析及 Kaplan-Meier 生存曲线分析临床、病理和治疗变量对局部无复发生存（LRFS）、无转移生存（MFS）和总生存（OS）的预后影响。
共纳入 84 例患者，平均年龄为 41.8±21.9 岁。中位随访 6（平均 7.4）个月后，局部复发率为 14.3%。7 例患者（8.3%）发生转移，65 例患者在平均随访 52.6±39.8 个月后无疾病证据存活。肿瘤大小>5cm、G3 级肿瘤和切缘<10mm 显著增加局部复发率。切缘≥10mm 和年龄<45 岁显著提高累积生存率。切缘<10mm 和肿瘤分级 G3 是转移的显著多变量危险因素。
尽管我们国家的医疗转诊系统较差，但我们的结果与发达国家的报告没有不同。手术切缘和肿瘤分级对 LRFS、MFS 和 OS 具有预后影响。
