从对10000例软组织肉瘤患者的研究中吸取的经验教训。

Lessons learned from the study of 10,000 patients with soft tissue sarcoma.

作者信息

Brennan Murray F, Antonescu Cristina R, Moraco Nicole, Singer Samuel

机构信息

*Departments of Surgery; and †Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.

出版信息

Ann Surg. 2014 Sep;260(3):416-21; discussion 421-2. doi: 10.1097/SLA.0000000000000869.

Abstract

BACKGROUND AND OBJECTIVE

The management of rare tumors is difficult because of limited information on natural history. Our objective was to describe a long-term comprehensive prospective database with the assumption that with careful attention to patient, predisposing tumor and treatment variables, valuable knowledge could be obtained that could guide management.

METHODS

In July of 1982, we began a prospective database of all adult patients admitted to our institution for a surgical procedure for soft tissue sarcoma. Patients were included if they had primary, locally recurrent or metastatic disease undergoing a surgical procedure.

RESULTS

Over 3 decades, we entered 10,000 patients into our prospective soft tissue sarcoma database. Data were entered on a weekly or biweekly schedule with full participation of a multidisciplinary team and a dedicated sarcoma pathologist. Extensive information is available from this database. In this article, we describe distribution by site, histopathology, sex, size, and grade. We utilize this information along with outcome data for local recurrence, distant recurrence, disease specific, and overall survival. The value of molecular diagnosis is illustrated.

CONCLUSIONS

Continuous prospective long-term databases are important to obtain knowledge particularly for rare tumors. Such data can be a rich resource for the development of prognostic indicators including nomograms and can be analyzed by Bayesian Belief Networks. These long-term data linked to collection of tumor and germ-line tissue at the time of an initial procedure will remain a resource for future decades.

摘要

背景与目的

由于关于自然病史的信息有限,罕见肿瘤的管理颇具难度。我们的目标是建立一个长期全面的前瞻性数据库,假定通过仔细关注患者、诱发肿瘤及治疗变量,能够获取有价值的知识以指导管理。

方法

1982年7月,我们开始建立一个前瞻性数据库,纳入所有因软组织肉瘤手术入院的成年患者。若患者患有原发性、局部复发性或转移性疾病并接受手术,则纳入该数据库。

结果

在30多年间,我们将10000例患者纳入前瞻性软组织肉瘤数据库。数据按每周或每两周的时间表录入,多学科团队及一名专业肉瘤病理学家全程参与。该数据库提供了丰富的信息。在本文中,我们描述了按部位、组织病理学、性别、大小和分级的分布情况。我们利用这些信息以及局部复发、远处复发、疾病特异性和总生存的结局数据。阐述了分子诊断的价值。

结论

持续的前瞻性长期数据库对于获取知识尤为重要,特别是对于罕见肿瘤。此类数据可成为开发包括列线图在内的预后指标的丰富资源,并可通过贝叶斯信念网络进行分析。这些与初次手术时肿瘤和生殖系组织收集相关的长期数据将在未来几十年仍是一种资源。

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