Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Department of Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
Surg Oncol. 2020 Sep;34:292-297. doi: 10.1016/j.suronc.2020.06.003. Epub 2020 Jun 30.
BACKGROUND/OBJECTIVE: Natural history and outcomes for truncal/extremity (TE) soft tissue sarcoma (STS) is derived primarily from studies investigating all histiotypes as one homogenous cohort. We aimed to define the recurrence rate (RR), recurrence patterns, and response to radiation of TE leiomyosarcomas (LMS).
Patients from the US Sarcoma Collaborative database with primary, high-grade TE STS were identified. Patients were grouped into LMS or other histology (non-LMS). Primary endpoints were locoregional recurrence-free survival (LR-RFS), distant-RFS (D-RFS), and disease specific survival (DSS).
Of 1215 patients, 93 had LMS and 1122 non-LMS. In LMS patients, median age was 63 and median tumor size was 6 cm. In non-LMS patients, median age was 58 and median tumor size was 8 cm. In LMS patients, overall RR was 42% with 15% LR-RR and 29% D-RR. The 3yr LR-RFS, D-RFS, and DSS were 84%, 65%, and 76%, respectively. When considering high-risk (>5 cm and high-grade, n = 49) LMS patients, the overall RR was 45% with 12% LR-RR and 35% D-RR. 61% received radiation. The 3yr LR-RFS (78vs93%, p = 0.39), D-RFS (53vs63%, p = 0.27), and DSS (67vs91%, p = 0.17) were similar in those who did and did not receive radiation. High-risk, non-LMS patients had a similar overall RR of 42% with 15% LR-RR and 30% D-RR. 60% of non-LMS patients received radiation. There was an improved 3yr LR-RFS (82vs75%, p = 0.030) and DSS (77vs65%,p = 0.007) in non-LMS patients who received radiation.
In our cohort, patients with LMS have a low local recurrence rate (12-15%) and modest distant recurrence rate (29-35%). However, LMS patients had no improvement in local control or long-term outcomes with radiation. The value of radiation in these patients merits further investigation.
背景/目的：躯干/肢体（TE）软组织肉瘤（STS）的自然病史和结局主要来源于研究所有组织型为一个同质队列的研究。我们旨在确定 TE 平滑肌肉瘤（LMS）的复发率（RR）、复发模式和对放疗的反应。
从美国肉瘤协作数据库中确定了患有原发性、高级别 TE STS 的患者。患者被分为 LMS 或其他组织学类型（非-LMS）。主要终点是局部区域无复发生存率（LR-RFS）、远处无复发生存率（D-RFS）和疾病特异性生存率（DSS）。
在 1215 名患者中，93 名患有 LMS，1122 名患有非-LMS。在 LMS 患者中，中位年龄为 63 岁，中位肿瘤大小为 6cm。在非-LMS 患者中，中位年龄为 58 岁，中位肿瘤大小为 8cm。在 LMS 患者中，总体 RR 为 42%，LR-RR 为 15%，D-RR 为 29%。3 年 LR-RFS、D-RFS 和 DSS 分别为 84%、65%和 76%。在考虑高危（>5cm 和高级别，n=49）LMS 患者时，总体 RR 为 45%，LR-RR 为 12%，D-RR 为 35%。61%的患者接受了放疗。LR-RFS（78vs93%，p=0.39）、D-RFS（53vs63%，p=0.27）和 DSS（67vs91%，p=0.17）在接受和未接受放疗的患者中相似。高危非-LMS 患者的总体 RR 相似，为 42%，LR-RR 为 15%，D-RR 为 30%。60%的非-LMS 患者接受了放疗。接受放疗的非-LMS 患者 3 年 LR-RFS（82vs75%，p=0.030）和 DSS（77vs65%，p=0.007）均有所提高。
在我们的队列中，LMS 患者局部复发率较低（12-15%），远处复发率适中（29-35%）。然而，LMS 患者接受放疗并不能改善局部控制或长期预后。放疗在这些患者中的价值值得进一步研究。
