Bray Jonathan P, Polton Gerry A, McSporran Keith D, Bridges Janis, Whitbread Trevor M
Massey University Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand.
Vet Surg. 2014 Oct;43(7):774-82. doi: 10.1111/j.1532-950X.2014.12185.x. Epub 2014 Apr 12.
To determine outcome of dogs with a diagnosis of soft tissue sarcoma managed in first opinion practice.
Retrospective, case-controlled study
Dogs (n = 350) with primary occurrence of a soft tissue sarcoma.
A previously validated questionnaire was sent to all veterinarians requesting clinical information and ultimate outcome for all dogs. Histologic sections were reviewed by a single pathologist.
Most surgeries were unplanned, with only 15 (4%) dogs having a histologic and 59 (16.8%) dogs having a cytologic diagnosis before surgery. Median survival time for all dogs was not reached with 70% proportional survival at 5 years. Local recurrence developed in 73 (20.8%) cases. The extent of resection performed was not associated with improved survival (P = .2) or tumor recurrence (P = .8). Age <8 years (χ(2) = 6.1; P = .01), tumors <5 cm in size (χ(2) = 9.6; P = .002) and discrete tumors (χ(2) = 16.6; P < .001) had improved survival outcomes. On multivariate analysis, a high tumor grade was significant for recurrence (HR 5.8; P < .001; 95% CI: 2.2-14.8). Evidence of a selection bias towards less aggressive tumors being managed in first opinion practice was confirmed.
Wide resection margins are not the primary determinant of outcome for all soft tissue sarcoma. Veterinarians need to better understand the biologic behavior of a suspected soft tissue sarcoma before treatment to allow surgical margins to be adjusted accordingly.
确定在初诊实践中诊断为软组织肉瘤的犬的预后情况。
回顾性病例对照研究
原发性软组织肉瘤的犬(n = 350)
向所有兽医发送一份预先验证过的问卷,要求提供所有犬的临床信息和最终预后情况。组织学切片由一名病理学家进行复查。
大多数手术为非计划性手术,只有15只(4%)犬在手术前有组织学诊断,59只(16.8%)犬有细胞学诊断。所有犬的中位生存时间未达到,5年时的比例生存率为70%。73例(20.8%)出现局部复发。切除范围与生存率提高(P = 0.2)或肿瘤复发(P = 0.8)无关。年龄<8岁(χ² = 6.1;P = 0.01)、肿瘤大小<5 cm(χ² = 9.6;P = 0.002)和边界清晰的肿瘤(χ² = 16.6;P < 0.001)的生存预后较好。多因素分析显示,肿瘤高分级对复发有显著影响(HR 5.8;P < 0.001;95% CI:2.2 - 14.8)。证实)。证实了在初诊实践中对侵袭性较小的肿瘤存在选择偏倚的证据。
广泛的手术切缘并非所有软组织肉瘤预后的主要决定因素。兽医在治疗前需要更好地了解疑似软组织肉瘤的生物学行为,以便相应地调整手术切缘。