Cananzi Ferdinando Carlo Maria, Mussi Chiara, Bordoni Maria Grazia, Marrari Andrea, De Sanctis Rita, Colombo Piergiuseppe, Quagliuolo Vittorio
Surgical Oncology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Vascular Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
J Surg Oncol. 2016 Jul;114(1):44-9. doi: 10.1002/jso.24244. Epub 2016 Apr 6.
The optimal treatment of leiomyosarcoma (LMS) of the inferior vena cava (IVC) is still unclear, especially in the metastatic and/or recurrent setting. We herein evaluated the long-term outcome after aggressive management.
Eleven patients underwent surgery for primary LMS of the IVC between 2000 and 2012. The clinical, pathological, and survival data were reviewed.
The IVC was managed by graft replacement in four cases, primary repair in four, and ligation in three. The R0 resection rate was 64%. The median follow-up was 60 months. Nine patients developed distant relapse, two of them concomitant local recurrence; no exclusive local recurrence was observed. The 3- and 5-year distant recurrence free survival were 30% and 10%, respectively. The 3- and 5-year overall-survival (OS) were 77.8%. The presence of residual disease after surgery (P = 0.024) and the time to recurrence (P = 0.033) were associated with the OS in a univariate analysis. The time to recurrence was related to the post-metastases survival (P = 0.032).
An adequate surgery minimizes the risk of local recurrence and remains the main treatment for primary LMS of the IVC. Nevertheless, the rate of distant metastases remains extremely high. An aggressive surgical policy may be of benefit to selected patients with metastatic disease. J. Surg. Oncol. 2016;114:44-49. © 2016 Wiley Periodicals, Inc.
下腔静脉平滑肌肉瘤（LMS）的最佳治疗方案仍不明确，尤其是在发生转移和/或复发的情况下。我们在此评估积极治疗后的长期疗效。
2000年至2012年间，11例患者接受了下腔静脉原发性LMS手术。回顾了临床、病理和生存数据。
4例患者行血管移植置换下腔静脉，4例行一期修复，3例行结扎。R0切除率为64%。中位随访时间为60个月。9例患者发生远处复发，其中2例伴有局部复发；未观察到单纯局部复发。3年和5年无远处复发生存率分别为30%和10%。3年和5年总生存率（OS）为77.8%。单因素分析显示，术后残留病灶的存在（P = 0.024）和复发时间（P = 0.033）与OS相关。复发时间与转移后生存相关（P = 0.032）。
充分的手术可将局部复发风险降至最低，仍然是下腔静脉原发性LMS的主要治疗方法。然而，远处转移率仍然极高。积极的手术策略可能对部分转移性疾病患者有益。《外科肿瘤学杂志》2016年；114：44 - 49。© 2016威利期刊公司
