Division of Surgical Oncology, Department of Surgery, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2017 Nov;24(12):3574-3586. doi: 10.1245/s10434-017-6034-9. Epub 2017 Sep 11.
Postoperative complications (POCs) negatively impact oncologic outcomes in some malignancies; however, little is known regarding their effect in soft tissue sarcoma (STS). The aim of this study was to determine the impact of POCs on survival after resection of truncal and extremity STS.
All patients who underwent resection for a primary truncal or extremity STS at a single academic institution from 2000 to 2015 were included and analyzed. Primary outcome was disease-specific survival (DSS).
Among 546 STS patients, POCs occurred in 159 (29%) patients; 57% were major and 55% were surgical site infections. Patients with POCs were older (61 vs. 53 years), had more comorbidities (50 vs. 38%), longer operative time (127 vs. 93 min), higher-grade tumors (93 vs. 86%), and were more likely to receive preoperative radiation (42 vs. 33%; all p < 0.05). There was no difference in receipt of postoperative therapy between the POCs and no POCs groups (19 vs. 18%, p = 0.74). Median follow-up for survivors was 37 months, and the 5-year DSS for the entire cohort was 78%. Compared with patients without POCs, patients with POCs had a worse DSS (68% vs. 81%, p = 0.001). Predictors for decreased DSS on univariate analysis included POCs (hazard ratio [HR] 2.12, 95% confidence interval [CI] 1.37-3.28, p = 0.001), advanced age, neurovascular/bone resection, positive margin, high grade, and preoperative and postoperative therapy (all p < 0.05). POCs (HR 1.76, 95% CI 1.08-2.87, p = 0.02) remained an independent predictor for reduced DSS on multivariate analysis, along with age (HR 1.02, p = 0.046) and tumor grade (HR 7.62, p = 0.046).
POCs following resection of truncal and extremity STS are associated with decreased DSS. Efforts to optimize modifiable risk factors and decrease the rate of POCs warrant further investigation.
术后并发症（POC）会对某些恶性肿瘤的肿瘤学结局产生负面影响；然而，关于其对软组织肉瘤（STS）的影响知之甚少。本研究旨在确定 POC 对单一学术机构 2000 年至 2015 年间接受原发性躯干或四肢 STS 切除术患者的生存结果的影响。
本研究纳入并分析了在单一学术机构接受原发性躯干或四肢 STS 切除术的所有患者。主要结局为疾病特异性生存（DSS）。
在 546 名 STS 患者中，159 名（29%）患者发生了 POC；57%为主要 POC，55%为手术部位感染。发生 POC 的患者年龄更大（61 岁比 53 岁），合并症更多（50%比 38%），手术时间更长（127 分钟比 93 分钟），肿瘤分级更高（93%比 86%），且更有可能接受术前放疗（42%比 33%；所有 P<0.05）。POC 组和无 POC 组患者术后治疗的接受率无差异（19%比 18%，P=0.74）。幸存者的中位随访时间为 37 个月，整个队列的 5 年 DSS 为 78%。与无 POC 的患者相比，发生 POC 的患者 DSS 更差（68%比 81%，P=0.001）。单因素分析中，降低 DSS 的预测因素包括 POC（风险比[HR]2.12，95%置信区间[CI]1.37-3.28，P=0.001）、高龄、神经血管/骨切除、阳性切缘、高级别和术前及术后治疗（均 P<0.05）。多因素分析中，POC（HR 1.76，95%CI 1.08-2.87，P=0.02）以及年龄（HR 1.02，P=0.046）和肿瘤分级（HR 7.62，P=0.046）仍然是降低 DSS 的独立预测因素。
躯干和四肢 STS 切除术后发生 POC 与降低 DSS 相关。进一步调查优化可改变的危险因素和降低 POC 发生率的努力是值得的。
