Saebye Casper, Fugloe Hanna M, Nymark Tine, Safwat Akmal, Petersen Michael M, Baad-Hansen Thomas, Krarup-Hansen Anders, Keller Johnny
a Department of Experimental Clinical Oncology , Aarhus University Hospital , Aarhus , Denmark.
b Department of Orthopedic Surgery , Aarhus University Hospital , Aarhus , Denmark.
Acta Oncol. 2017 Feb;56(2):239-244. doi: 10.1080/0284186X.2016.1268267. Epub 2017 Jan 12.
Limb-sparing surgery for sarcomas has become possible in most cases. However, the impact of the procedure on the functional outcome has only been investigated in a few studies. The aim of this study has been to identify tumor- and patient-related factors associated with reduced functional outcome and quality of life after limb-sparing surgery in soft tissue sarcoma patients.
In total, 128 patients (mean age = 58, female/male = 54/74) who were treated with limb-sparing surgery without bone resection for soft tissue sarcomas in Denmark during the period 1 January 2009 to 31 December 2011 were included. Patients were asked to participate at least one year after surgery, and patients who had experienced local recurrence or metastatic disease were excluded. The Toronto Extremity Salvage Score (TESS) measured functional disability, while the Musculoskeletal Tumor Society Score (MSTS) measured functional impairment. European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 measured quality of life. Tumor- and patient-related factors (age, gender, tumor depth, tumor size, malignancy, comorbidity, location, and radiotherapy) were extracted from the Danish National Sarcoma Database. Wilcoxon rank-sum test and Kruskal-Wallis were used for univariable analysis. Adjusted odds ratios were estimated by using multiple logistic regression models.
In the multiple regression analysis, it was found that female gender (p = 0.03), lower extremity tumors (p < 0.01) and radiotherapy (p = 0.02) resulted in an increased risk of a lower TESS score. Initial reduced postoperative function was found to be associated with a lower functional outcome. Patients with reduced functional outcome have increased risk for reduced quality of life (p < 0.01).
The results of this study show that patient- and tumor-related factors have an important role in the functional outcome.
在大多数情况下，肉瘤的保肢手术已成为可能。然而，该手术对功能结局的影响仅在少数研究中得到调查。本研究的目的是确定与软组织肉瘤患者保肢手术后功能结局降低和生活质量相关的肿瘤和患者相关因素。
纳入2009年1月1日至2011年12月31日期间在丹麦接受保肢手术且未进行骨切除的128例软组织肉瘤患者（平均年龄=58岁，女性/男性=54/74）。要求患者在手术后至少一年参与研究，排除经历局部复发或转移性疾病的患者。多伦多肢体挽救评分（TESS）用于测量功能残疾，肌肉骨骼肿瘤学会评分（MSTS）用于测量功能障碍。欧洲癌症研究与治疗组织（EORTC）QLQ-C30用于测量生活质量。从丹麦国家肉瘤数据库中提取肿瘤和患者相关因素（年龄、性别、肿瘤深度、肿瘤大小、恶性程度、合并症、位置和放疗）。采用Wilcoxon秩和检验和Kruskal-Wallis进行单变量分析。使用多元逻辑回归模型估计调整后的优势比。
在多元回归分析中，发现女性（p=0.03）、下肢肿瘤（p<0.01）和放疗（p=0.02）导致TESS评分降低的风险增加。术后初始功能降低与较低的功能结局相关。功能结局降低的患者生活质量降低的风险增加（p<0.01）。
本研究结果表明，患者和肿瘤相关因素在功能结局中起重要作用。
