边缘状态和局部复发对软组织肉瘤结局的影响。

Impact of margin status and local recurrence on soft-tissue sarcoma outcomes.

机构信息

Departments of Orthopaedics (B.K.P., C.B.H., and J.A.F) and Surgery (P.F.H. and J.C.G.), Walter Reed National Military Medical Center, 8901 Rockville Pike, America Building (Building 19), 2nd Floor, Orthopaedics, Bethesda, MD 20889. E-mail address for B.K. Potter:

出版信息

J Bone Joint Surg Am. 2013 Oct 16;95(20):e151. doi: 10.2106/JBJS.L.01149.

DOI:10.2106/JBJS.L.01149

PMID:24132366

Abstract

BACKGROUND

The impact of local recurrence and surgical resection margin status on survival in extremity soft-tissue sarcomas remains to be clearly defined. Our aim was to conduct a retrospective analysis of prospectively collected data to determine the prognostic relevance of positive resection margins and local recurrence for extremity soft-tissue sarcomas for survival.

METHODS

Three hundred and sixty-three patients who underwent resection of localized primary extremity soft-tissue sarcomas with curative intent were selected from the United States Department of Defense Automated Central Tumor Registry. Outcomes for local recurrence, distant recurrence, disease-specific survival, and overall survival were analyzed according to clinical, pathological, and treatment variables with use of the Kaplan-Meier method (log-rank test) and the multivariate Cox regression model.

RESULTS

Positive margins (hazard ratio, 1.99 [95% confidence interval, 1.15 to 3.45]), local recurrence (hazard ratio, 2.93 [95% confidence interval, 1.38 to 6.23]), and distant recurrence (hazard ratio, 12.13 [95% confidence interval, 5.97 to 24.65]) were significantly associated with overall survival on multivariate Cox regression analysis. However, for disease-specific survival, local recurrence was not significant and tumor size of >10 cm (hazard ratio, 2.83 [95% confidence interval, 1.15 to 6.95]), positive margins (hazard ratio, 1.95 [95% confidence interval, 1.05 to 3.63]), and distant recurrence (hazard ratio, 9.46 [95% confidence interval, 4.37 to 20.47]) were independent adverse prognostic factors. The disease-specific survival rate for patients with localized soft-tissue sarcomas was 89% (95% confidence interval, 85% to 92%) for five years and 75% (95% confidence interval, 70% to 81%) for ten years.

CONCLUSIONS

Positive surgical margins are consistently associated with adverse survival-related outcomes in localized soft-tissue sarcomas of the extremity. Local recurrence had a significant impact on overall survival, but not on disease-specific survival.

摘要

背景

局部复发和手术切缘状态对肢体软组织肉瘤生存的影响仍需明确界定。我们的目的是对前瞻性收集的数据进行回顾性分析，以确定阳性切缘和局部复发对肢体软组织肉瘤生存的预后相关性。

方法

从美国国防部自动中央肿瘤登记处选择 363 例接受根治性切除局限性肢体原发性软组织肉瘤的患者。根据临床、病理和治疗变量，采用 Kaplan-Meier 法（对数秩检验）和多变量 Cox 回归模型分析局部复发、远处复发、疾病特异性生存率和总生存率。

结果

阳性切缘（危险比，1.99[95%置信区间，1.15 至 3.45]）、局部复发（危险比，2.93[95%置信区间，1.38 至 6.23]）和远处复发（危险比，12.13[95%置信区间，5.97 至 24.65]）在多变量 Cox 回归分析中与总生存率显著相关。然而，对于疾病特异性生存率，局部复发无显著意义，肿瘤直径>10cm（危险比，2.83[95%置信区间，1.15 至 6.95]）、阳性切缘（危险比，1.95[95%置信区间，1.05 至 3.63]）和远处复发（危险比，9.46[95%置信区间，4.37 至 20.47]）是独立的不良预后因素。局限性软组织肉瘤患者的疾病特异性生存率为五年时 89%（95%置信区间，85%至 92%），十年时 75%（95%置信区间，70%至 81%）。