Kuwahara Hiroaki, Salo Juho, Nevala Riikka, Tukiainen Erkki
Department of Oncology, Helsinki University Hospital, Finland.
Ann Plast Surg. 2019 Jul;83(1):82-88. doi: 10.1097/SAP.0000000000001901.
We report our single-institution, multidisciplinary experience of nearly 20 years of working on chest wall soft tissue sarcoma cases. The aim of this study was to evaluate clinical outcomes in patients with chest wall soft tissue sarcoma.
A retrospective review of 49 surgically treated patients with chest wall soft tissue sarcoma was conducted from 1997 to 2015.
The median age of the patients was 57.0 years. There were 19 full-thickness and 30 partial-thickness resections. Reconstruction was warranted in 37 cases. Sarcomas were high grade in 31 (63.3%) and low grade in 18 (36.7%) cases. Local recurrence developed in 8 and metastasis in 9 patients. No 30-day mortality occurred. By the end of the study period, 35 patients were alive and 14 had died. The 1-, 5-, and 10-year survival rates were 93.8%, 76.0%, and 71.6%, whereas the overall recurrence-free rates were 84.4%, 70.7%, and 70.7% respectively. Favorable prognostic variables for survival included age <50 years and radical treatment (resection with wide margin or resection with marginal margin and adjuvant radiotherapy). Patients who had undergone nonradical treatment had a 3.1-fold lower chance of survival than did those who had undergone radical treatment (95% confidence interval, 0.96-10.12; P = 0.06).
Our study suggests that surgical resection with wide margins should continue to be the mainstay for patients with chest wall sarcoma. Even extensive chest wall resections and reconstructions are safe. If wide margins are not achieved, (neo)adjuvant radiotherapy should be considered to improve local control.
我们报告了我们单一机构近20年来处理胸壁软组织肉瘤病例的多学科经验。本研究的目的是评估胸壁软组织肉瘤患者的临床结局。
对1997年至2015年接受手术治疗的49例胸壁软组织肉瘤患者进行回顾性研究。
患者的中位年龄为57.0岁。全层切除19例，部分厚度切除30例。37例需要进行重建。31例（63.3%）肉瘤为高级别，18例（36.7%）为低级别。8例出现局部复发，9例发生转移。未发生30天内死亡。到研究期结束时，35例患者存活，14例死亡。1年、5年和10年生存率分别为93.8%、76.0%和71.6%，而总体无复发生存率分别为84.4%、70.7%和70.7%。生存的有利预后因素包括年龄<50岁和根治性治疗（广泛边缘切除或边缘切除加辅助放疗）。接受非根治性治疗的患者生存机会比接受根治性治疗的患者低3.1倍（95%置信区间，0.96 - 10.12；P = 0,06）。
我们的研究表明，广泛边缘的手术切除应继续作为胸壁肉瘤患者的主要治疗方法。即使是广泛的胸壁切除和重建也是安全的。如果未达到广泛边缘，应考虑（新）辅助放疗以改善局部控制。
