Charoenlap Chris, Imanishi Jungo, Tanaka Takaaki, Slavin John, Ngan Samuel Y, Chander Sarat, Dowsey Michelle Maree, Goyal Chatar, Choong Peter F M
Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.
Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok 10400, Thiland, Thailand.
Cancer Med. 2016 Jun;5(6):980-8. doi: 10.1002/cam4.615. Epub 2016 Mar 1.
This study aimed to compare the oncological results between unplanned excision (UE) and planned excision (PE) of malignant soft tissue tumor and to examine the impact of residual tumor (ReT) after UE. Nonmetastatic soft tissue sarcomas surgically treated in 1996-2012 were included in this study. Disease-specific survival (DSS), metastasis-free survival (MFS), and local-recurrence-free survival (LRFS) were stratified according to the tumor location and American Joint Committee on Cancer Classification 7th edition stage. Independent prognostic parameters were identified by Cox proportional hazard models. Two-hundred and ninety PEs and 161 UEs were identified. Significant difference in oncological outcome was observed only for LRFS probability of retroperitoneal sarcomas (5-year LRFS: 33.0% [UE] vs. 71.0% [PE], P = 0.018). Among the 142 UEs of extremity and trunk, ReT in re-excision specimen were found in 75 cases (53%). UEs with ReT had significantly lower survival probabilities and a higher amputation rate than UEs without ReT (5-year DSS: 68.8% vs. 92%, P < 0.001; MFS: 56.1% vs. 90.9%, P < 0.001; LRFS: 75.8% vs. 98.4%, P = <0.001; amputation rate 18.5% vs. 1.8%, P = 0.003). The presence of ReT was an independent poor prognostic predictor for DSS, MFS, and LRFS with hazard ratios of 2.02 (95% confidence interval (CI), 1.25-3.26), 1.62 (95% CI, 1.05-2.51) and 1.94 (95% CI, 1.05-3.59), respectively. Soft tissue sarcomas should be treated in specialized centers and UE should be avoided because of its detrimental effect especially when ReT remains after UE.
本研究旨在比较恶性软组织肿瘤的计划外切除（UE）和计划切除（PE）的肿瘤学结果，并探讨UE后残留肿瘤（ReT）的影响。本研究纳入了1996年至2012年接受手术治疗的非转移性软组织肉瘤患者。根据肿瘤位置和美国癌症联合委员会第7版分期对疾病特异性生存率（DSS）、无转移生存率（MFS）和无局部复发生存率（LRFS）进行分层。通过Cox比例风险模型确定独立的预后参数。共识别出290例PE和161例UE。仅观察到腹膜后肉瘤的LRFS概率存在显著差异（5年LRFS：33.0%[UE]对71.0%[PE]，P = 0.018）。在142例肢体和躯干的UE中，75例（53%）在再次切除标本中发现有ReT。有ReT的UE的生存率显著低于无ReT的UE，截肢率更高（5年DSS：68.8%对92%，P < 0.001；MFS：56.1%对90.9%，P < 0.001；LRFS：75.8%对98.4%，P = <0.001；截肢率18.5%对1.8%，P = 0.003）。ReT的存在是DSS、MFS和LRFS的独立不良预后预测因素，风险比分别为2.02（95%置信区间（CI），1.25 - 3.26）、1.62（95%CI，1.05 - 2.51）和1.94（95%CI，1.05 - 3.59）。软组织肉瘤应在专科中心进行治疗，应避免UE，因为其具有有害影响，尤其是当UE后仍有ReT时。
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