Tsuda Yusuke, Ogura Koichi, Kobayashi Eisuke, Hiruma Toru, Iwata Shintaro, Asano Naofumi, Kawai Akira, Chuman Hirokazu, Ishii Takeshi, Morioka Hideo, Kobayashi Hiroshi, Kawano Hirotaka
Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo.
Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo.
Jpn J Clin Oncol. 2017 May 1;47(5):422-429. doi: 10.1093/jjco/hyx016.
Patients aged ≥65 years requiring surgery for soft-tissue sarcoma are a concern in an aging society. We aimed to reveal the association of clinical/geriatric factors with survival period or postoperative events in such patients who underwent surgery.
We enrolled patients aged ≥65 years who underwent surgery for localized soft-tissue sarcoma at five institutions. We retrospectively collected clinical/geriatric factors and laboratory data, and analyzed their association with outcomes using univariate and multivariate analyses.
Among the 202 patients included, mean age at presentation was 73 years. Surgical margin was R0 in 139 patients (69%). The Eastern Cooperative Oncology Group performance status was ≥2 in 15 (7%). Thirty patients (15%) showed thinness (body mass index <18.49 kg/cm2). High-sensitivity-modified Glasgow prognostic score ≥1 was seen in 52 patients (26%). Multivariate analysis showed that R1 surgical margin was significantly correlated with poor sarcoma-specific survival (hazard ratio for R1 vs. R0, 3.17; P = 0.001) and event-free survival (hazard ratio for R1 vs. R0, 2.56; P < 0.001). Higher Eastern Cooperative Oncology Group performance status was significantly associated with poor sarcoma-specific survival (hazard ratio for ≥2 vs. 0 or 1, 2.15; P = 0.038), and higher sensitivity-modified Glasgow prognostic score was significantly associated with poor event-free survival (hazard ratio for ≥1 vs. 0, 1.74; P = 0.046). Severe thinness (body mass index <16.00) was a risk factor for postoperative events (odds ratio for body mass index <16.00 vs. ≥16.00, 8.15, P = 0.010).
Negative surgical margin was associated with better survival. Coexisting conditions had an impact on outcomes in elderly soft-tissue sarcoma patients.
在老龄化社会中，年龄≥65岁需要接受软组织肉瘤手术的患者备受关注。我们旨在揭示此类接受手术治疗的患者的临床/老年因素与生存期或术后事件之间的关联。
我们纳入了在五家机构接受局限性软组织肉瘤手术的年龄≥65岁的患者。我们回顾性收集了临床/老年因素和实验室数据，并使用单因素和多因素分析来分析它们与预后的关联。
在纳入的202例患者中，就诊时的平均年龄为73岁。139例患者（69%）手术切缘为R0。东部肿瘤协作组体能状态≥2的患者有15例（7%）。30例患者（15%）体重过轻（体重指数<18.49kg/cm²）。52例患者（26%）高敏改良格拉斯哥预后评分≥1。多因素分析显示，R1手术切缘与较差的肉瘤特异性生存期显著相关（R1与R0相比的风险比，3.17；P = 0.001）以及无事件生存期（R1与R0相比的风险比，2.56；P < 0.001）。较高的东部肿瘤协作组体能状态与较差的肉瘤特异性生存期显著相关（≥2与0或1相比的风险比，2.15；P = 0.038），较高的高敏改良格拉斯哥预后评分与较差的无事件生存期显著相关（≥1与0相比的风险比，1.74；P = 0.046）。严重体重过轻（体重指数<16.00）是术后事件的危险因素（体重指数<16.00与≥16.00相比的比值比，8.15，P = 0.010）。
阴性手术切缘与更好的生存期相关。并存疾病对老年软组织肉瘤患者的预后有影响。
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