Surgical Oncology Resident Doctor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
Assistant Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
Cancer Treat Res Commun. 2021;27:100326. doi: 10.1016/j.ctarc.2021.100326. Epub 2021 Jan 27.
Primary chest wall sarcoma is a rare entity. It can be classified based on its origin, as bone sarcomas or soft tissue sarcomas. Various prognostic factors have been studied in different case series like age, sex, tumor histology, grade, resection margin status, adjuvant treatment, and others. The present study aimed to analyze common histological types, their management by resection and reconstruction and prognosis, in cases presenting at a regional cancer center in western India.
This was an observational study from a prospectively maintained database. 57 patients with chest wall sarcoma treated with curative intent between January 2016 till January 2019 with a minimum follow-up of 3 months were included in the study. The goals of surgical treatment were to obtain a wide resection margin of 3-4 cm, preserve the function of the chest wall and provide stability and rigidity to protect intrathoracic organs.
The median follow-up of the present patient's cohort was for 20.2 months. Overall two-year survival was 74.7%. Two-year OS and DFS of bone sarcoma were 62.3% and 35% and soft tissue sarcomas were 91% and 71.3%. Ewing's sarcoma had the worst two-year overall survival of 50.6% and chondrosarcoma and fibromatosis had 100% two-year overall survival.
Chest wall sarcoma forms a heterogeneous group of tumors. In the present study, Ewing's sarcoma was the most common histology with the worst survival, since they presented in advanced stages. Management should be multidisciplinary and surgical resection should be aggressive to achieve an R0 resection. Reconstruction of chest wall should aim to provide structural and functional stability with minimal morbidity. Frozen section assessment should be utilized whenever in doubt.
原发性胸壁肉瘤较为罕见，可以根据其起源进行分类，包括骨肉瘤和软组织肉瘤。在不同的病例系列中，已经研究了各种预后因素，如年龄、性别、肿瘤组织学、分级、切缘状态、辅助治疗等。本研究旨在分析在印度西部一个地区癌症中心就诊的患者中，常见的组织学类型、通过切除和重建进行的治疗以及预后。
这是一项来自前瞻性维护数据库的观察性研究。纳入了 2016 年 1 月至 2019 年 1 月期间接受以治愈为目的治疗且随访时间至少为 3 个月的 57 例胸壁肉瘤患者。手术治疗的目标是获得 3-4cm 的广泛切缘，保留胸壁的功能，并提供稳定性和刚性以保护胸腔内器官。
本患者队列的中位随访时间为 20.2 个月。总体两年生存率为 74.7%。骨肉瘤的两年 OS 和 DFS 分别为 62.3%和 35%，软组织肉瘤的 OS 和 DFS 分别为 91%和 71.3%。尤文肉瘤的两年总生存率最差，为 50.6%，软骨肉瘤和纤维瘤的两年总生存率均为 100%。
胸壁肉瘤是一组异质性肿瘤。在本研究中，尤文肉瘤是最常见的组织学类型，生存最差，因为它们处于晚期。管理应该是多学科的，手术切除应该是积极的，以实现 R0 切除。胸壁重建的目的应该是提供结构和功能稳定性，同时尽量减少发病率。在有疑问时，应利用冷冻切片评估。
