Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Thorac Surg. 2014 Apr;97(4):1379-85. doi: 10.1016/j.athoracsur.2013.12.030. Epub 2014 Feb 22.
Primary cardiac sarcomas are rare diseases with a poor prognosis. This study aims to provide a prognostic analysis after different levels of resections of cardiac sarcomas.
Twenty-nine patients undergoing resections of primary cardiac sarcomas at the Zhongshan Hospital from September 1995 to July 2012 were retrospectively reviewed.
There were 15 women and 14 men. The mean age was 41.0 years. The most common histologic type was angiosarcoma (28%). The median survival for the entire cohort was 17 months (range, 5 to 216 months). Patients with microscopically negative margin (R0) resections had a better median survival than those with microscopically positive margin (R1) resections (58 months versus 11 months; p<0.001). The median survival after an R1 resection was not different from that after a partial resection (12 months; p=0.81). The median local recurrence-free survival after an R0 resection was longer than that after an R1 resection (36 months versus 6 months; p<0.001). Five patients who underwent R0 resections and repeated resections of local recurrences or metastases had the longest median survival of 72 months. None of the patients with R0 resections received adjuvant therapy. Multimodality treatment after R1 and partial resections slightly increased the survival.
For nonmetastatic and localized primary cardiac sarcoma, an R0 surgical resection of cardiac sarcomas should be performed. Aggressive surgical treatment or radiation therapy for local recurrence or metastasis prolongs the survival. Multimodality treatment is recommended after incomplete resections of cardiac sarcomas. The role of adjuvant chemotherapy after R0 resections is unclear.
原发性心脏肉瘤是一种预后较差的罕见疾病。本研究旨在对不同水平的心脏肉瘤切除术进行预后分析。
回顾性分析 1995 年 9 月至 2012 年 7 月在中山医院行原发性心脏肉瘤切除术的 29 例患者的临床资料。
患者中，女性 15 例，男性 14 例，平均年龄为 41.0 岁。最常见的组织学类型是血管肉瘤（28%）。全组患者的中位生存时间为 17 个月（范围：5~216 个月）。肿瘤切缘阴性（R0 切除）患者的中位生存时间优于肿瘤切缘阳性（R1 切除）患者（58 个月比 11 个月；p<0.001）。R1 切除后的中位生存时间与部分切除后的中位生存时间无差异（12 个月；p=0.81）。R0 切除后局部无复发生存的中位时间长于 R1 切除后（36 个月比 6 个月；p<0.001）。5 例 R0 切除后局部复发或转移患者行 R0 切除和局部复发或转移重复切除术，中位生存时间最长，为 72 个月。R0 切除患者均未接受辅助治疗。R1 切除和部分切除后采用多模式治疗可略微提高生存率。
对于非转移性和局限性原发性心脏肉瘤，应行 R0 手术切除。对局部复发或转移行积极的手术治疗或放疗可延长生存时间。建议对心脏肉瘤不完全切除患者采用多模式治疗。R0 切除后辅助化疗的作用尚不清楚。
