Jablons D, Steinberg S M, Roth J, Pittaluga S, Rosenberg S A, Pass H I
Surgery Branch, National Institutes of Health, Bethesda, MD 20892.
J Thorac Cardiovasc Surg. 1989 May;97(5):695-705.
Between 1982 and 1987, 74 patients (46 men and 28 women) had exploration for presumed metastases from high-grade soft tissue sarcoma of the head/neck, extremity, or trunk. Ages ranged from 11 to 75 years (median 38 years). Thirty (41%) had multiple procedures for recurrences (range two to six explorations). Median postthoracotomy time for the group of patients with histologically confirmed sarcoma (n = 63) was 20.3 months. Patients rendered free of disease at initial thoracotomy had significantly longer postthoracotomy survival times (26.8 months median) than those with unresectable metastatic disease (9 months median); p2 less than 0.0001). The prognostic significance of age, sex, location of primary tumor, disease-free interval, number of nodules on preoperative computed tomograms or conventional linear tomograms, number of metastases resected, and the use of postoperative chemotherapy were analyzed. In a univariate analysis, sex, age, and location of the primary tumor did not impact significantly on survival, nor did the use of postoperative chemotherapy. Initial disease-free interval of 1 year or less was associated with a significantly shorter survival time, and patients with five nodules or fewer on preoperative computed tomography had significantly longer survival times than patients with six nodules or more. Patients with three nodules or fewer on linear tomography had a longer postthoracotomy survival time than patients with four nodules or more. In patients whose malignant disease could be completely resected, the number of nodules resected at thoracotomy did not impact on long-term survival. According to proportional-hazards modeling, disease-free interval, sex, resectability, and truncal location were found to associate with length of survival after metastasis removal. We conclude that pulmonary metastasis resection in patients with soft tissue sarcoma is associated with long-term survival, and consistent indicators can define which patients may benefit from these interventions.
1982年至1987年间，74例患者（46例男性和28例女性）因怀疑头颈部、四肢或躯干高级别软组织肉瘤发生转移而接受了探查。年龄范围为11至75岁（中位年龄38岁）。30例（41%）因复发接受了多次手术（范围为2至6次探查）。组织学确诊为肉瘤的患者组（n = 63）开胸术后的中位时间为20.3个月。初次开胸时疾病清除的患者开胸术后生存时间显著长于无法切除转移性疾病的患者（中位时间分别为26.8个月和9个月；p2<0.0001）。分析了年龄、性别原发肿瘤位置、无病间期、术前计算机断层扫描或传统线性断层扫描上的结节数量、切除的转移灶数量以及术后化疗的使用情况对预后的影响。单因素分析显示，性别、年龄、原发肿瘤位置以及术后化疗的使用对生存率均无显著影响。初始无病间期为1年或更短与显著较短的生存时间相关，术前计算机断层扫描上有5个或更少结节的患者比有6个或更多结节的患者生存时间显著更长。线性断层扫描上有3个或更少结节的患者开胸术后生存时间比有4个或更多结节的患者更长。在恶性疾病能够完全切除的患者中，开胸时切除的结节数量对长期生存无影响。根据比例风险模型，发现无病间期、性别、可切除性和躯干位置与转移灶切除后的生存长度相关。我们得出结论，软组织肉瘤患者的肺转移灶切除与长期生存相关，一致的指标可以确定哪些患者可能从这些干预措施中获益。
