Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan.
Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan.
J Orthop Sci. 2022 Mar;27(2):468-472. doi: 10.1016/j.jos.2020.12.025. Epub 2021 Feb 5.
Due to their rarity, soft tissue sarcomas (STS)s are often treated surgically as unplanned excisions (UE)s before referral to specialists. The Bone and Soft Tissue Tumor (BSTT) registry is a nationwide, organ-specific cancer registry for bone and soft-tissue tumors in Japan. The aim of this study was to elucidate the incidence and risk factors for UEs using data from the BSTT registry.
Our study comprised 8761 patients with STS including 4826 males and 3935 females, with a mean age of 59 years (range, 0-105 years). Patients were classified into primary STS and UE groups.
Superficial and deep tumors were found in 2533 and 6120 patients, respectively. The mean STS size was 8.6 cm (range, 0.2-49 cm). We identified 6610 patients with high-grade, and 1758 patients with low-grade STS. Of the total 8761 patients, 7770 patients had primary STSs, whereas 991 patients were referred after undergoing UE. The UE mean incidence rate over 11 years was 11.3%. The UE incidence rates for leiomyosarcoma (LMS) (odds ratio [OR] = 1.75, p < 0.0001), fibrosarcoma (FS) (OR = 2.28, p < 0.0001), and epithelioid sarcoma (OR = 1.82, p = 0.01) were higher than the mean UE incidence rate (11.3%). Of 757 patients who underwent UE, 354 (47%) patients had superficial (≤5 cm) STSs, whereas 156 (20.6%) of patients had deep STSs (>5 cm) (p < 0.0001). Logistic regression analysis revealed that UE was frequently associated with males and small, superficial, and trunk STSs.
In the present study, the mean UE incidence rate (11.3%) was significantly different from the individual UE incidence rates of histological diagnoses suggesting that surgeons should consider STS, even with small tumors. Continuous education during training for medical students and surgeons is essential to ensure awareness and correct diagnostic procedures for STS.
由于软组织肉瘤（STS）较为罕见，在转诊给专家之前，通常会作为计划外切除术（UE）进行外科治疗。骨与软组织肿瘤（BSTT）登记处是日本针对骨与软组织肿瘤的一个全国性、器官特异性癌症登记处。本研究旨在利用 BSTT 登记处的数据阐明 UE 的发生率和危险因素。
我们的研究包括 8761 名 STS 患者，其中男性 4826 名，女性 3935 名，平均年龄为 59 岁（范围 0-105 岁）。患者被分为原发性 STS 和 UE 组。
分别有 2533 名和 6120 名患者患有浅表和深部肿瘤。STS 的平均大小为 8.6cm（范围 0.2-49cm）。我们发现 6610 名患者为高级别，1758 名患者为低级别 STS。在 8761 名患者中，7770 名患者为原发性 STS，991 名患者在接受 UE 后被转诊。11 年内 UE 的平均发生率为 11.3%。平滑肌肉瘤（LMS）（比值比 [OR] = 1.75，p < 0.0001）、纤维肉瘤（FS）（OR = 2.28，p < 0.0001）和上皮样肉瘤（OR = 1.82，p = 0.01）的 UE 发生率高于平均 UE 发生率（11.3%）。在进行 UE 的 757 名患者中，354 名（47%）患者患有浅表（≤5cm）STS，而 156 名（20.6%）患者患有深部 STS（>5cm）（p < 0.0001）。Logistic 回归分析显示，UE 常与男性、小、浅表和躯干 STS 相关。
在本研究中，平均 UE 发生率（11.3%）与组织学诊断的个体 UE 发生率显著不同，这表明外科医生即使面对小肿瘤也应考虑 STS。对医学生和外科医生进行持续的培训教育对于提高认识和正确的 STS 诊断程序至关重要。
