Nishida Yoshihiro, Tsukushi Satoshi, Urakawa Hiroshi, Sugiura Hideshi, Nakashima Hiroatsu, Yamada Yoshihisa, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan,
Int J Clin Oncol. 2014;19(3):536-43. doi: 10.1007/s10147-013-0571-4. Epub 2013 Jun 4.
Rhabdomyosarcoma has different extension patterns, including a higher propensity for lymph nodes metastasis, compared with other types of soft tissue sarcoma. The aims of this study were to investigate the patterns of regional and distant metastasis in patients with rhabdomyosarcomas, particularly lymphatic route metastasis, and clarify the clinical factors that affect the pattern of metastasis.
Forty-four patients with rhabdomyosarcomas were enrolled in this study. The mean age of the patients was 26 (range 1-69) years, and 18 were males. The histological subtypes included alveolar (17 patients), embryonal (10 patients), pleomorphic (7 patients), and unknown (10 patients). Based on location, the sarcomas were divided into three groups: extremity (17 cases), favorable prognosis (10 cases), and unfavorable prognosis (15 cases). There were three cases (7 %) of local relapse, ten cases of regional lymph node relapse, and three cases of in-transit metastasis (total 30 %). Twenty-one patients (48 %) developed distant metastases. Initial sites of metastases were bone (9 patients, 20 %), lung (5 patients), and bone marrow dissemination (5 patients). Clinico-pathological variables affecting relapse patterns were analyzed.
Of the three cases of local relapse, two were alveolar type and one was unknown. The three cases of in-transit metastasis were all alveolar type. Patients with alveolar type had a significantly high propensity for lymph node metastasis (P = 0.027). Excluding the pleomorphic type, alveolar type was still a significant factor for lymph node metastasis (P = 0.017).
Physicians should be aware of in-transit spread, particularly in patients with alveolar-type rhabdomyosarcoma. Novel treatment modalities are required to detect and treat in-transit metastasis.
与其他类型的软组织肉瘤相比，横纹肌肉瘤具有不同的扩散模式，包括更高的淋巴结转移倾向。本研究的目的是调查横纹肌肉瘤患者的区域和远处转移模式，特别是淋巴途径转移，并阐明影响转移模式的临床因素。
本研究纳入了44例横纹肌肉瘤患者。患者的平均年龄为26岁（范围1 - 69岁），男性18例。组织学亚型包括肺泡型（17例患者）、胚胎型（10例患者）、多形性（7例患者）和未知型（10例患者）。根据部位，肉瘤分为三组：肢体（17例）、预后良好（10例）和预后不良（15例）。有3例（7%）局部复发，10例区域淋巴结复发，3例途中转移（共30%）。21例患者（48%）发生远处转移。转移的初始部位为骨（9例患者，20%）、肺（5例患者）和骨髓播散（5例患者）。分析了影响复发模式的确切病理变量。
在3例局部复发中，2例为肺泡型，1例为未知型。3例途中转移均为肺泡型。肺泡型患者的淋巴结转移倾向显著较高（P = 0.027）。排除多形性类型后，肺泡型仍是淋巴结转移的重要因素（P = 0.017）。
医生应注意途中扩散，特别是肺泡型横纹肌肉瘤患者。需要新的治疗方式来检测和治疗途中转移。
