Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan.
Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
Surg Oncol. 2020 Dec;35:303-308. doi: 10.1016/j.suronc.2020.08.022. Epub 2020 Aug 26.
Whilst the resection margin is an established factor predictive of local control of soft-tissue sarcomas (STSs), the adequacy of margin width for low-grade STSs has been rarely described. We aimed to investigate the margin adequacy and its prognostic relevance in low-grade STSs.
109 patients who underwent surgical treatment for a low-grade STS were studied. The prognostic value of margin status was evaluated according to the R-, R+1-classification, and width in millimetres.
The 10-year local recurrence (LR) rates were 6%, 27%, 54% in R0, R1, and R2, respectively (p < 0.001), according to the R-classification. The R+1-classification resulted in a decreased LR rate in R1, but no major differences in LR rates in R0 and R2; 7%, 14%, 54% in R0, R1, and R2, respectively (p < 0.001). When classified by metric distance, 10-year LR rates were 0%, 8%, and 38% by ≥ 2.0 mm, 0.1-1.9 mm, and 0 mm margins, respectively (p < 0.001). Patients with close margins (0.1-1.9 mm) who received adjuvant radiotherapy had a trend toward lower LR risk than those without radiotherapy (10-year, 4% vs. 12%; p = 0.406). The 5 and 10-year disease-specific mortality was 9% and 13%, respectively; margin width was not associated with disease-specific mortality but LR was a poor prognostic factor for survival (p = 0.003).
Whilst negative margin provided local control over 90%, excellent local control was achieved with microscopic margins ≥2 mm. The role of margins is more important than radiotherapy in local control. Margins do not determine survival, but LR is associated with a poor prognosis.
虽然切缘是预测软组织肉瘤（STS）局部控制的一个既定因素，但低级别 STS 的切缘宽度是否足够的描述却很少见。我们旨在研究低级别 STS 的切缘充分性及其预后相关性。
研究了 109 例接受低级别 STS 手术治疗的患者。根据 R-、R+1 分类和毫米数评估切缘状态的预后价值。
根据 R 分类，R0、R1 和 R2 的 10 年局部复发（LR）率分别为 6%、27%和 54%（p<0.001）。R+1 分类导致 R1 的 LR 率降低，但 R0 和 R2 的 LR 率无明显差异；R0、R1 和 R2 的 LR 率分别为 7%、14%和 54%（p<0.001）。按度量距离分类，切缘≥2.0mm、0.1-1.9mm 和 0mm 的 10 年 LR 率分别为 0%、8%和 38%（p<0.001）。接受辅助放疗的切缘较近（0.1-1.9mm）的患者，LR 风险低于未接受放疗的患者（10 年，4%对 12%；p=0.406）。5 年和 10 年的疾病特异性死亡率分别为 9%和 13%；切缘宽度与疾病特异性死亡率无关，但 LR 是生存的不良预后因素（p=0.003）。
尽管阴性切缘提供了超过 90%的局部控制，但微观切缘≥2mm 可实现极佳的局部控制。切缘的作用比放疗更重要，在局部控制中起决定性作用。切缘不决定生存，但 LR 与预后不良相关。
