O'Donnell Patrick W, Griffin Anthony M, Eward William C, Sternheim Amir, Catton Charles N, Chung Peter W, O'Sullivan Brian, Ferguson Peter C, Wunder Jay S
Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada.
Cancer. 2014 Sep 15;120(18):2866-75. doi: 10.1002/cncr.28793. Epub 2014 Jun 3.
The objectives of this study were to evaluate the risk of local recurrence and survival after soft tissue sarcoma (STS) resection with positive margins and to evaluate the safety of sparing adjacent critical structures.
One hundred sixty-nine patients with localized STS who had positive resection margins were identified from a prospective database. Patients who had positive margins were stratified into 3 groups, each representing a specific clinical scenario: critical structure positive margin (eg major nerve, vessel, or bone), tumor bed resection positive margin, and unexpected positive margin. The rates of local recurrence-free survival (LRFS) and cause-specific survival (CSS) were calculated and compared with relevant control patients who had negative margins after STS resection.
After planned close dissection to preserve critical structures, the 5-year LRFS and CSS rates both depended on the quality of the surgical margins (97% and 80.3%, respectively, for those with negative margins vs 85.4% and 59.4%, respectively, for those with positive margins; P = .015 and P = .05, respectively). Negative margins achieved through resection of critical structures because of tumor invasion or encasement only slightly improved the 5-year rates of LRFS (91.2%) and CSS (63.6%; P = .8 and P = .9, respectively). The lowest 5-year LRFS and CSS rates were 63.4% and 59.2%, respectively, after an unexpected positive margin during primary surgery.
After patients undergo resection of STS with positive margins, oncologic outcomes can be predicted based on the clinical context. Sparing adjacent critical structures in this setting is safe and contributes to improved functional outcomes.
本研究的目的是评估软组织肉瘤（STS）切缘阳性切除术后局部复发和生存的风险，并评估保留相邻关键结构的安全性。
从一个前瞻性数据库中识别出169例局部STS切缘阳性的患者。切缘阳性的患者被分为3组，每组代表一种特定的临床情况：关键结构切缘阳性（如主要神经、血管或骨骼）、肿瘤床切除切缘阳性和意外切缘阳性。计算局部无复发生存率（LRFS）和特定病因生存率（CSS），并与STS切除术后切缘阴性的相关对照患者进行比较。
在计划进行仔细解剖以保留关键结构后，5年LRFS和CSS率均取决于手术切缘的质量（切缘阴性者分别为97%和80.3%，切缘阳性者分别为85.4%和59.4%；P分别为0.015和0.05）。因肿瘤侵犯或包裹而通过切除关键结构实现的阴性切缘仅略微提高了5年LRFS率（91.2%）和CSS率（63.6%；P分别为0.8和0.9）。初次手术时意外切缘阳性后，5年LRFS和CSS率最低，分别为63.4%和59.2%。
患者接受STS切缘阳性切除术后，可根据临床情况预测肿瘤学结局。在此情况下保留相邻关键结构是安全的，有助于改善功能结局。
