黏液纤维肉瘤患者局部复发的预测因素

Predictors of Local Recurrence in Patients With Myxofibrosarcoma.

作者信息

Odei Bismarck, Rwigema Jean-Claude, Eilber Frederick R, Eilber Fritz C, Selch Michael, Singh Arun, Chmielowski Bartosz, Nelson Scott D, Wang Pin-Chieh, Steinberg Michael, Kamrava Mitchell

机构信息

David Geffen School of Medicine.

Departments of Radiation Oncology.

出版信息

Am J Clin Oncol. 2018 Sep;41(9):827-831. doi: 10.1097/COC.0000000000000382.

DOI:10.1097/COC.0000000000000382

PMID:28640064

Abstract

OBJECTIVES

Myxofibrosarcoma (MFS) is reported to have a higher risk of local recurrence (LR) following definitive surgical excision relative to other soft tissue sarcomas. We reviewed our clinical experience treating MFS to investigate predictors of LR.

MATERIALS AND METHODS

We retrospectively reviewed treatment outcomes for MFS patients treated at our institution between 1999 and 2015. A total of 52 patients were identified. Median age was 65 years (range, 21 to 86 y). Site of disease was: upper extremity (27%), lower extremity (46%), trunk (15%), pelvic (8%), and head and neck (4%). Patients had low, intermediate, high-grade, and unknown grade in: 23%, 8%, 67%, and 2% of tumors, respectively. Tumors were categorized as ≤5 cm (35%), >5 cm (56%), or unknown size (9%). In total, 71% received radiotherapy: 19% preoperative, 50% postoperative, and 2% both. All patients underwent surgery. Margins were negative in 71%, close/positive in 21%, and unknown in 8%. In total, 27% of patients received chemotherapy. Univariate Cox regression analysis was utilized to determine associations between clinical and treatment factors with LR.

RESULTS

Median follow-up time was 2.9 years (range, 0.4 to 14.3 y). The 3-year actuarial LR, distant metastasis, and overall survival were: 31%, 15%, and 87%, respectively. Predictors of LR were patient age greater than or equal to the median of 65 years (hazard ratio, 13.46, 95% confidence interval, 1.71-106.18, P=0.013), and having close/positive tumor margins (hazard ratio, 3.4, 95% confidence interval, 1-11.53, P=0.049).

CONCLUSIONS

In this institutional series of MFS older age and positive/close margins were significantly associated with a higher risk of LR.

摘要

目的

据报道，与其他软组织肉瘤相比，黏液纤维肉瘤（MFS）在根治性手术切除后局部复发（LR）风险更高。我们回顾了我们治疗MFS的临床经验，以研究LR的预测因素。

材料与方法

我们回顾性分析了1999年至2015年间在本机构接受治疗的MFS患者的治疗结果。共确定了52例患者。中位年龄为65岁（范围21至86岁）。疾病部位为：上肢（27%）、下肢（46%）、躯干（15%）、骨盆（8%）和头颈部（4%）。肿瘤分级为低、中、高分级以及分级未知的患者分别占：23%、8%、67%和2%。肿瘤分为≤5 cm（35%）、>5 cm（56%）或大小未知（9%）。总计71%的患者接受了放疗：19%为术前放疗，50%为术后放疗，2%为术前术后均放疗。所有患者均接受了手术。切缘阴性的患者占71%，切缘接近/阳性的患者占21%，切缘情况未知的患者占8%。总计27%的患者接受了化疗。采用单因素Cox回归分析来确定临床和治疗因素与LR之间的关联。

结果

中位随访时间为2.9年（范围0.4至14.3年）。3年精算LR、远处转移和总生存率分别为：31%、15%和87%。LR的预测因素为患者年龄大于或等于65岁的中位数（风险比，13.46，95%置信区间，1.71 - 106.18，P = 0.013），以及肿瘤切缘接近/阳性（风险比，3.4，95%置信区间，1 - 11.53，P = 0.049）。