Trovik Linn H, Ovrebo Kjell, Almquist Martin, Haugland Hans Kristian, Rissler Pehr, Eide Johan, Engellau Jacob, Monge Odd R, Nyhus Anniken B, Elde Ingvild K, Jebsen Nina L
Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen , Bergen , Norway.
Acta Oncol. 2014 Sep;53(9):1165-72. doi: 10.3109/0284186X.2014.921723. Epub 2014 Jul 7.
Currently there is no consensus on the use of adjuvant radiotherapy (RT) in retroperitoneal sarcoma (RPS). We have analysed clinical outcomes in patients with localised RPS treated at two Scandinavian Sarcoma Group (SSG) centres: Haukeland University Hospital (HUH), Bergen, Norway and Skåne University Hospital (SUH), Lund, Sweden to clarify the effects of adjuvant RT on local control and overall survival (OS).
Local databases and registers at HUH and SUH as well as the SSG central register were used to identify RPS patients. Patients with localised RPS who underwent surgery in Bergen between 1988 and 2009 and in Lund from 1998 to 2009 were included. Medical records were examined for clinical data, tumour characteristics, treatment factors and follow-up status. Archived tumour sections and tumour tissue were reviewed, and when necessary, restained and reclassified. Cox regression was used to analyse the association of potential prognostic factors with local recurrence-free survival (LRFS), metastasis-free survival (MFS) and OS.
The study included 97 patients: 52 from Norway and 45 from Sweden. The proportion of high-grade tumours was 73%. The five-year LRFS, MFS and OS were 55%, 59% and 60%, respectively. RT was significantly associated with improved local control resulting in a five-year LRFS of 77% compared with 39% without (p < 0.001). Furthermore, five-year OS was 71% in the RT group in contrast to 52% with surgery alone (p = 0.019). In the adjusted analysis RT proved to be a significant factor also for MFS (HR = 0.42, 95% CI 0.20-0.88, p = 0.021). In addition, high-grade malignancy, large tumour and positive surgical margin were risk factors for local recurrence. High malignancy grade was the only significant adverse prognostic factor for metastasis. High age and high-grade malignancy were negative prognostic factors for OS.
Adjuvant RT was significantly associated with an improved five-year LRFS and OS.
目前对于腹膜后肉瘤（RPS）辅助放疗（RT）的应用尚无共识。我们分析了在两个斯堪的纳维亚肉瘤研究组（SSG）中心接受治疗的局限性RPS患者的临床结局：挪威卑尔根的豪克兰大学医院（HUH）和瑞典隆德的斯科讷大学医院（SUH），以阐明辅助放疗对局部控制和总生存期（OS）的影响。
使用HUH和SUH的本地数据库及登记册以及SSG中央登记册来识别RPS患者。纳入1988年至2009年在卑尔根以及1998年至2009年在隆德接受手术的局限性RPS患者。检查病历以获取临床数据、肿瘤特征、治疗因素和随访状态。复查存档的肿瘤切片和肿瘤组织，必要时重新染色并重新分类。采用Cox回归分析潜在预后因素与无局部复发生存期（LRFS）、无转移生存期（MFS）和OS的相关性。
该研究纳入97例患者，其中52例来自挪威，45例来自瑞典。高级别肿瘤的比例为73%。五年LRFS、MFS和OS分别为55%、59%和60%。放疗与改善局部控制显著相关，五年LRFS为77%，而未接受放疗者为39%（p<0.001）。此外，放疗组的五年OS为71%，而单纯手术组为52%（p = 0.019）。在多因素分析中，放疗被证明也是MFS的显著因素（HR = 0.42，95%CI 0.20 - 0.88，p = 0.021）。此外，高级别恶性肿瘤、肿瘤体积大及手术切缘阳性是局部复发的危险因素。高恶性级别是转移的唯一显著不良预后因素。高龄和高级别恶性肿瘤是OS的不良预后因素。
辅助放疗与改善五年LRFS和OS显著相关。
