化疗可改善肢体/躯干局部高级别软组织肉瘤的远处控制。

Chemotherapy improves distant control in localized high-grade soft tissue sarcoma of the extremity/trunk.

作者信息

Rizk Victoria T, Naghavi Arash O, Brohl Andrew S, Joyce David M, Binitie Odion, Kim Youngchul, Hanna John P, Swank Jennifer, Gonzalez Ricardo J, Reed Damon R, Druta Mihaela

机构信息

Department of Hematology and Oncology, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612 USA.

Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL USA.

出版信息

Clin Sarcoma Res. 2020 Jul 9;10:11. doi: 10.1186/s13569-020-00132-w. eCollection 2020.

DOI:10.1186/s13569-020-00132-w

PMID:32670544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7350709/

Abstract

BACKGROUND

Soft tissue sarcomas (STS) are rare and heterogeneous tumors making chemotherapy use controversial. Our goal was to identify a subset of patients with primary STS that benefit with the addition of chemotherapy.

METHODS

A retrospective chart review included intermediate to high-grade localized primary STS of the extremity/trunk, and tumor size > 5 cm. The effect of chemotherapy was evaluated for local control (LC), distant control (DC), progression free survival (PFS), and overall survival (OS).

RESULTS

In this cohort (n = 273), patients were treated with surgery (98%), radiation (81%), and chemotherapy (24.5%). With a median follow-up of 51 months, the entire cohort's 5-year LC, DC, PFS, and OS are 79.1%, 59.9%, 43.8%, and 68.7%, respectively. The addition of chemotherapy did not provide a DC benefit (p = 0.238) for the entire cohort. High-grade disease (n = 210) experienced a 5-year benefit in DC (68% vs. 54.4%, p = 0.04), which was more pronounced with MAI (Mesna, Adriamycin, Ifosfamide) based regimens (74.2%, p = 0.016), and a 5-year PFS (50.8% vs 45%, p = 0.025) and OS benefit (76.2% vs 70%, p = 0.067) vs. no chemotherapy. On multivariate analysis of the high-grade subset, chemotherapy independently predicted for a DC benefit (HR 0.48 95% CI 0.26-89, p = 0.019). The benefit of chemotherapy was more pronounced with MAI, showing a significant benefit in DC (HR 0.333 95% CI 0.145-0.767, p = 0.01) and PFS (HR 0.52 95% CI 0.28-0.99, p = 0.047).

CONCLUSION

In patients with localized STS > 5 cm, the high-grade subset had a distant control benefit with the addition of chemotherapy, leading to improved progression free survival. This is more pronounced with the use of MAI and should be considered in patients eligible for this regimen.

摘要

背景

软组织肉瘤（STS）是罕见的异质性肿瘤，化疗的应用存在争议。我们的目标是确定一部分原发性STS患者，他们能从化疗中获益。

方法

一项回顾性病历审查纳入了肢体/躯干的中高级别局限性原发性STS，且肿瘤大小>5厘米。评估化疗对局部控制（LC）、远处控制（DC）、无进展生存期（PFS）和总生存期（OS）的影响。

结果

在这个队列（n = 273）中，患者接受了手术（98%）、放疗（81%）和化疗（24.5%）。中位随访51个月，整个队列的5年LC、DC、PFS和OS分别为79.1%、59.9%、43.8%和68.7%。化疗的加入对整个队列未提供远处控制益处（p = 0.238）。高级别疾病（n = 210）在远处控制方面有5年益处（68%对54.4%，p = 0.04），基于美司钠、阿霉素、异环磷酰胺（MAI）方案更显著（74.2%，p = 0.016），与未化疗相比有5年PFS益处（50.8%对45%，p = 0.025）和总生存期益处（76.2%对70%，p = 0.067）。在高级别亚组的多因素分析中，化疗独立预测远处控制益处（风险比0.48，95%置信区间0.26 - 0.89，p = 0.019）。化疗在MAI方案中益处更显著，在远处控制（风险比0.333，95%置信区间0.145 - 0.767，p = 0.01）和PFS（风险比0.52，95%置信区间0.28 - 0.99，p = 0.047）方面显示出显著益处。