Ortiz-Ibáñez Bárbara, Amaya José V, Baixauli Francisco, Angulo Manuel, Mayordomo-Aranda Empar, Barrios Carlos
Department of Orthopedic Surgery, Hospital de Sagunto, Valencia, Spain.
Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain.
World J Surg Oncol. 2015 Jun 25;13:206. doi: 10.1186/s12957-015-0622-6.
There is still no consensus regarding the management of patients with massive liposarcomas located in the extremities. Several discrepancies related to the aggressiveness of the surgery and the application of concomitant radiotherapy and chemotherapy treatments remain controversial. The purpose of this study was to analyse the clinicopathological characteristics, prognostic factors and outcomes of a series of patients with massive liposarcomas of the extremities who were treated at a referral hospital specializing in musculoskeletal oncology.
This was an observational, descriptive and retrospective case series covering 10 years of clinical practice. The records of 26 adults, 14 men and 12 women, with localized massive liposarcomas in the extremities were studied. The average age was 53 years. The patients were treated from January 2003 until January 2012. Wide surgical resections with limb-sparing surgeries were performed for most patients (96.2 %).
The average tumour size was 15.1 ± 6.8 cm in the greatest dimension. Regarding the histological subtypes, there were 11 well-differentiated or atypical lipomatous tumours (42.3 %), 10 myxoid (38.5 %) and 5 (19.2 %) round cell and pleomorphic liposarcomas. Regarding the malignancy grades, 19 cases (73 %) were classified as low grade. Among these low-grade tumours predominated the well-differentiated subtype (57.9 %). Within high-grade tumours, the round cell and pleomorphic subtype was most frequent (57.1 %; p = 0.011). Radiotherapy was additionally applied to 12 patients (46.2 %) and adjuvant chemotherapy to 5 (19.3 %). Tumour recurrence was observed in only 2 cases (7.7 %). Only 1 of these cases developed lung metastatic dissemination.
Across the entire series, these massive tumours did not compromise the survival of the patients. The histologic subtype and the malignancy degree were closely related. Proper and early diagnosis and therapeutic management of these patients via the application of wide-margin surgical excision are essential to ensure long-term survival.
对于四肢巨大脂肪肉瘤患者的治疗，目前仍未达成共识。在手术的激进程度以及同步放化疗的应用方面存在的一些差异仍存在争议。本研究的目的是分析在一家专门从事肌肉骨骼肿瘤学的转诊医院接受治疗的一系列四肢巨大脂肪肉瘤患者的临床病理特征、预后因素及治疗结果。
这是一个涵盖10年临床实践的观察性、描述性和回顾性病例系列研究。研究了26例成人患者的记录，其中男性14例，女性12例，均患有四肢局限性巨大脂肪肉瘤。平均年龄为53岁。患者于2003年1月至2012年1月接受治疗。大多数患者（96.2%）接受了保肢的广泛手术切除。
肿瘤最大径的平均大小为15.1±6.8厘米。在组织学亚型方面，有11例高分化或非典型脂肪瘤性肿瘤（42.3%），10例黏液样（38.5%），5例（19.2%）圆形细胞和多形性脂肪肉瘤。在恶性程度方面，19例（73%）被归类为低级别。在这些低级别肿瘤中，高分化亚型占主导（57.9%）。在高级别肿瘤中，圆形细胞和多形性亚型最为常见（57.1%；p=0.011）。另外12例患者（46.2%）接受了放疗，5例（19.3%）接受了辅助化疗。仅2例（7.7%）观察到肿瘤复发。其中只有1例发生了肺转移扩散。
在整个系列中，这些巨大肿瘤并未危及患者的生存。组织学亚型与恶性程度密切相关。通过广泛边缘手术切除对这些患者进行恰当和早期的诊断及治疗管理对于确保长期生存至关重要。
