Ohnstad Hege O, Bruland Oyvind S, Taksdal Ingeborg, Bjerkehagen Bodil, Nenadovic Maja, Sæter Gunnar, Jørgensen Lars H, Hall Kirsten Sundby
Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital , Oslo , Norway.
Acta Oncol. 2014 Sep;53(9):1180-7. doi: 10.3109/0284186X.2014.899433. Epub 2014 Apr 3.
Approximately 50% of patients with high-grade soft tissue sarcoma (STS) will develop pulmonary metastasis. This is the most frequent cause of death and improving treatment is warranted. Preoperative chemotherapy is used for selected patients, usually those with less favorable prognosis and mainly outside clinical trials. The predicted value of histological and radiological response to preoperative chemotherapy on outcome was the main focus for this investigation.
This retrospective study comprises 93 patients with metachronous lung metastasis from STS who underwent complete metastasectomy alone (n = 41) or metastasectomy following preoperative chemotherapy (n = 52). Clinical data, histological and radiological responses to chemotherapy were recorded and survival analyses performed.
The time from initial STS diagnosis to the appearance of metastasis was shorter in the preoperative chemotherapy group than in those treated with surgery alone (p = 0.02). However, no statistical differences in post-metastasis disease-specific survival (DSS) or progression-free survival (PFS) between the groups were demonstrated. Patients in the preoperative chemotherapy group with good (complete) histological response had improved PFS compared with poor responders (p = 0.04). Radiological partial response was an independent, favorable prognostic factor for improved PFS and DSS (p = 0.003).
Despite having unfavorable disease characteristics, some patients may benefit from preoperative chemotherapy. Both histological and radiological responses to preoperative chemotherapy seem to be prognostic in STS patients undergoing complete pulmonary metastasectomy.
约50%的高级别软组织肉瘤（STS）患者会发生肺转移。这是最常见的死亡原因，因此有必要改进治疗方法。术前化疗用于部分患者，通常是那些预后较差且主要不在临床试验中的患者。术前化疗的组织学和放射学反应对预后的预测价值是本研究的主要重点。
这项回顾性研究纳入了93例发生异时性肺转移的STS患者，他们单独接受了完全性转移灶切除术（n = 41）或术前化疗后行转移灶切除术（n = 52）。记录临床数据、化疗的组织学和放射学反应，并进行生存分析。
术前化疗组从最初诊断STS到出现转移的时间比单纯手术治疗组短（p = 0.02）。然而，两组之间转移后疾病特异性生存（DSS）或无进展生存（PFS）无统计学差异。术前化疗组中组织学反应良好（完全缓解）的患者与反应较差的患者相比，PFS有所改善（p = 0.04）。放射学部分缓解是PFS和DSS改善的独立有利预后因素（p = 0.003）。
尽管疾病特征不利，但部分患者可能从术前化疗中获益。术前化疗的组织学和放射学反应似乎对接受完全性肺转移灶切除术的STS患者具有预后意义。
