Cai Ling, Mirimanoff René-Olivier, Mouhsine Elyazid, Guillou Louis, Leyvraz Pierre-Francois, Leyvraz Serge, Gay Beatrice, Matzinger Oscar, Ozsahin Mahmut, Zouhair Abderrahim
Departments of Radiation Oncology, Vaud University Hospital Center , Lausanne, Switzerland.
Departments of Orthopedic Surgery, Vaud University Hospital Center , Lausanne, Switzerland.
Rare Tumors. 2013 Oct 18;5(4):e55. doi: 10.4081/rt.2013.e55. eCollection 2013.
The aim of the present study is to assess the disease profile, outcome and prognostic factors in patients treated with surgery combined with radiotherapy (RT), with or without chemotherapy (CXT), for soft-tissue sarcoma (STS) in a multidisciplinary setting. One hundred and sixty-four patients with STS treated between 1980 and 2010 at the Centre Hospitalier Universitaire Vaudois were enrolled in this retrospective study. Seventy-six percent of patients underwent postoperative RT with (24%), or without (52%) CXT, 15% preoperative RT with (5%), or without (10%) CXT, surgery alone (7%), or RT alone (2%) with or without CXT. The median follow-up was 60 months (range 6-292). Local failure was observed in 18%, and distant failure in 21% of the patients. Overall survival (OS), diseasefree survival (DFS), local control (LC) and distant metastases-free survival (DMFS) were 88%, 68%, 83%, and 79% at 5 years, and 80%, 56%, 76%, and 69% at 10 years, respectively. In univariate analyses, favorable prognostic factors for OS, DFS, and DMFS were tumor size 6 cm or less, World Health Organization (WHO)/Zubrod score 0, and stage 2 or less. Age and superficial tumors were favorable only for OS and DMFS respectively. STS involving the extremities had a better outcome regarding DFS and LC. Histological grade 2 or less was favorable for DFS, DMFS, and LC. Radical surgery was associated with better LC and DMFS. RT dose more than 60 Gy was favorable for OS, DFS, and LC. In multivariate analyses, independent factors were age for OS; tumor size for OS, DFS and DMFS; WHO/Zubrod score for OS, DFS and LC; hemoglobin level for DFS; site for DFS and LC; tumor depth for DMFS; histological grade for DFS and LC; surgical procedure for LC and DMFS; and RT dose for OS. This study confirms that in a multidisciplinary setting, STS have a fairly good prognosis. A number of prognostic and predictive factors, including the role of surgery combined with RT, were identified. Regarding RT, a dose of more than 60 Gy was associated with a better outcome, at the price of a higher toxicity. We could not demonstrate a superiority of preoperative RT over postoperative RT.
本研究旨在评估在多学科环境下接受手术联合放疗（RT）（无论是否联合化疗（CXT））治疗的软组织肉瘤（STS）患者的疾病概况、结局和预后因素。1980年至2010年期间在沃州大学中心医院接受治疗的164例STS患者纳入了这项回顾性研究。76%的患者接受了术后放疗，其中24%联合CXT，52%未联合CXT；15%接受了术前放疗，其中5%联合CXT，10%未联合CXT；单纯手术治疗（7%），或单纯放疗（2%），无论是否联合CXT。中位随访时间为60个月（范围6 - 292个月）。18%的患者出现局部复发，21%的患者出现远处复发。5年时总生存率（OS）、无病生存率（DFS）、局部控制率（LC）和无远处转移生存率（DMFS）分别为88%、68%、83%和79%，10年时分别为80%、56%、76%和69%。在单因素分析中，OS、DFS和DMFS的有利预后因素为肿瘤大小6 cm或更小、世界卫生组织（WHO）/Zubrod评分0以及分期2期或更低。年龄和浅表肿瘤分别仅对OS和DMFS有利。累及四肢的STS在DFS和LC方面结局较好。组织学分级2级或更低对DFS、DMFS和LC有利。根治性手术与更好的LC和DMFS相关。放疗剂量超过60 Gy对OS、DFS和LC有利。在多因素分析中，独立因素为OS的年龄；OS、DFS和DMFS的肿瘤大小；OS、DFS和LC的WHO/Zubrod评分；DFS的血红蛋白水平；DFS和LC的部位；DMFS的肿瘤深度；DFS和LC的组织学分级；LC和DMFS的手术方式；以及OS的放疗剂量。本研究证实，在多学科环境下，STS预后相当良好。确定了一些预后和预测因素，包括手术联合放疗的作用。关于放疗，剂量超过60 Gy与更好的结局相关，但代价是毒性更高。我们未能证明术前放疗优于术后放疗。
