Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Ann Surg Oncol. 2021 Aug;28(8):4706-4717. doi: 10.1245/s10434-020-09564-6. Epub 2021 Jan 28.
The need for systematic reexcision in patients who underwent unplanned excision (UE) for extremity and superficial trunk soft tissue sarcoma (ESTSTS) has been questioned. We investigated the outcome of patients who underwent reexcision for ESTSTS compared with primarily resected at our institution and the prognostic impact of microscopic residual disease (MR) in the reexcision specimen.
Primary ESTSTS patients surgically treated at our institution between 1997 and 2017 were divided in three groups: primarily resected (A), reexcised after macroscopically complete UE (B), and incomplete UE (C). Weighted overall survival (OS), crude cumulative incidence of local relapse (CCI-LR), and distant metastasis (CCI-DM) were calculated and compared. In group B, multivariable models were performed to assess factors associated with the outcomes.
A total of 1962 patients were identified: 1076, 697 and 189 in groups A, B, and C, respectively. Overall median follow-up was 85 months. Seven-year weighted-OS was 73.8%, 84.1%, and 80.7% (p < 0.001) for groups A, B, and C respectively. Seven-year CCI-LR and DM were 5.0% and 25.3%, 12.1% and 15.8%, and 13.6% and 29.4% (both p < 0.001) for groups A, B, and C, respectively. At multivariable analysis, the presence MR was associated with LR (p < 0.001) but not with OS nor CCI-DM.
UE and the presence of MR at pathology in reexcision specimen are associated to a higher risk of LR but not to a higher risk of DM or lower OS. After macroscopic complete UE, postponing reexcision until a LR occurs may be considered on an individualized basis.
对于因意外切缘（unplanned excision，UE）而行切除术的肢体和浅表躯干软组织肉瘤（extremity and superficial trunk soft tissue sarcoma，ESTSTS）患者，再次切除（reexcision）的必要性一直存在争议。本研究旨在探讨与我院初次手术切除相比，再次切除 ESTSTS 患者的预后，并分析再次切除标本中显微镜下残余疾病（microscopic residual disease，MR）的预后影响。
1997 年至 2017 年，我院收治的 ESTSTS 初治患者分为三组：初次手术切除（A 组）、UE 后行大体完全切除的再次切除（B 组）和 UE 不彻底的再次切除（C 组）。计算并比较三组患者的加权总生存（overall survival，OS）、局部复发累积发生率（local relapse cumulative incidence，CCI-LR）和远处转移累积发生率（distant metastasis cumulative incidence，CCI-DM）。在 B 组中，采用多变量模型评估与结局相关的因素。
共纳入 1962 例患者，A、B 和 C 组分别为 1076、697 和 189 例。中位随访时间为 85 个月。A、B 和 C 组患者的 7 年加权 OS 分别为 73.8%、84.1%和 80.7%（p < 0.001）。三组患者的 7 年 CCI-LR 和 CCI-DM 分别为 5.0%和 25.3%、12.1%和 15.8%、13.6%和 29.4%（均 p < 0.001）。多变量分析显示，MR 与 LR 相关（p < 0.001），但与 OS 和 CCI-DM 无关。
UE 和再次切除标本中存在 MR 与 LR 风险增加相关，但与 DM 风险增加或 OS 降低无关。对于 UE 患者，在出现局部复发时再行再次切除可能是一种个体化的治疗选择。
