Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Eur J Surg Oncol. 2014 Jan;40(1):49-54. doi: 10.1016/j.ejso.2013.09.004. Epub 2013 Sep 13.
The surgical management of soft tissue sarcoma (STS) in elderly patients has only been addressed in a few studies. The objective of the current study was to assess surgical outcomes in patients with STS aged 70 years and older and the association of older age with the survival after complete resection.
A retrospective analysis was conducted in 158 elderly patients with localized STS who visited 11 institutions participating in Japanese Musculoskeletal Oncology Group between 1995 and 2006 and were treated by surgical resection. Univariate and multivariate analyses were performed to identify prognostic factors.
Median follow-up period was 38 months. Histologically high-grade tumors were detected in 71% of the patients. Wide resection with adequate margins was performed in 66% of the cases. Systemic chemotherapy was performed in only 5 patients. Univariate analysis identified histological grade and gender as statistically significant prognostic factors for sarcoma-specific survival. Multivariate analysis did not identify significant prognostic factors for sarcoma-specific survival, although high grade sarcoma emerged as a potentially significant prognostic factor (P = 0.050). Local recurrence was detected in 19% of the patients. Multivariate analysis of local recurrence-free survival showed that tumor site and surgical margins were statistically significant prognostic factors.
Older age was not identified as a prognostic factor for sarcoma-specific survival, which is not consistent with the findings of previous studies showing that older age was associated with decreased sarcoma-specific survival. Complete resection should be indicated and can lead to optimal treatment outcome for properly selected elderly patients.
老年人软组织肉瘤（STS）的手术治疗仅在少数研究中有所涉及。本研究的目的是评估 70 岁及以上 STS 患者的手术结果，并探讨高龄与完全切除后生存的相关性。
对 1995 年至 2006 年间 11 家参与日本肌肉骨骼肿瘤学组的机构就诊的 158 名局部 STS 老年患者进行回顾性分析，并接受手术切除治疗。采用单因素和多因素分析来确定预后因素。
中位随访时间为 38 个月。71%的患者组织学上为高级别肿瘤。66%的病例行广泛切除且切缘足够。仅 5 例患者接受全身化疗。单因素分析发现组织学分级和性别是肉瘤特异性生存的统计学显著预后因素。多因素分析未发现肉瘤特异性生存的显著预后因素，但高级别肉瘤显示出潜在的显著预后因素（P=0.050）。19%的患者出现局部复发。局部无复发生存的多因素分析显示，肿瘤部位和手术切缘是统计学显著的预后因素。
高龄不是肉瘤特异性生存的预后因素，这与既往研究结果不一致，既往研究表明高龄与肉瘤特异性生存降低相关。对于适当选择的老年患者，完全切除应作为治疗选择，并可带来最佳的治疗效果。
