Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.
Dept of Orthopaedic and Traumatology, Helsinki University Central Hospital, Helsinki, Finland.
Bone Joint J. 2021 Jun;103-B(6):1150-1154. doi: 10.1302/0301-620X.103B6.BJJ-2020-1869.R1.
Controversy exists as to what should be considered a safe resection margin to minimize local recurrence in high-grade pelvic chondrosarcomas (CS). The aim of this study is to quantify what is a safe margin of resection for high-grade CS of the pelvis.
We retrospectively identified 105 non-metastatic patients with high-grade pelvic CS of bone who underwent surgery (limb salvage/amputations) between 2000 and 2018. There were 82 (78%) male and 23 (22%) female patients with a mean age of 55 years (26 to 84). The majority of the patients underwent limb salvage surgery (n = 82; 78%) compared to 23 (22%) who had amputation. In total, 66 (64%) patients were grade 2 CS compared to 38 (36%) grade 3 CS. All patients were assessed for stage, pelvic anatomical classification, type of resection and reconstruction, margin status, local recurrence, distant recurrence, and overall survival. Surgical margins were stratified into millimetres: < 1 mm; > 1 mm but < 2 mm; and > 2 mm.
The disease--specific survival (DSS) at five years was 69% (95% confidence interval (CI) 56% to 81%) and 51% (95% CI 31% to 70%) for grade 2 and 3 CS, respectively (p = 0.092). The local recurrence-free survival (LRFS) at five years was 59% (95% CI 45% to 72%) for grade 2 CS and 42% (95% CI 21% to 63%) for grade 3 CS (p = 0.318). A margin of more than 2 mm was a significant predictor of increased LRFS (p = 0.001). There was a tendency, but without statistical significance, for a > 2 mm margin to be a predictor of improved DSS. Local recurrence (LR) was a highly significant predictor of DSS, analyzed in a competing risk model (p = 0.001).
Obtaining wide margins in the pelvis remains challenging for high-grade pelvic CS. On the basis of our study, we conclude that it is necessary to achieve at least a 2 mm margin for optimal oncological outcomes in patients with high-grade CS of the pelvis. Cite this article: 2021;103-B(6):1150-1154.
对于高位骨盆软骨肉瘤（CS），为了将局部复发的风险最小化，应该将什么作为安全的切除边界仍存在争议。本研究旨在量化高位骨盆 CS 安全的切除边界。
我们回顾性地确定了 105 例在 2000 年至 2018 年间接受手术（保肢/截肢）治疗的非转移性高位骨盆 CS 患者。82 例（78%）为男性，23 例（22%）为女性，平均年龄为 55 岁（26 至 84 岁）。与接受截肢的 23 例（22%）相比，大多数患者接受了保肢手术（n=82；78%）。共有 66 例（64%）患者为 2 级 CS，38 例（36%）为 3 级 CS。所有患者均评估了分期、骨盆解剖学分类、切除和重建类型、切缘状态、局部复发、远处复发和总生存率。手术切缘以毫米为单位分层：<1mm；>1mm 但<2mm；>2mm。
5 年疾病特异性生存率（DSS）分别为 2 级 CS 的 69%（95%置信区间（CI）为 56%至 81%）和 3 级 CS 的 51%（95% CI 为 31%至 70%）（p=0.092）。5 年局部无复发生存率（LRFS）分别为 2 级 CS 的 59%（95% CI 为 45%至 72%）和 3 级 CS 的 42%（95% CI 为 21%至 63%）（p=0.318）。超过 2mm 的切缘是 LRFS 增加的显著预测因子（p=0.001）。有一个趋势，但没有统计学意义，表明>2mm 的切缘是 DSS 改善的预测因子。局部复发（LR）是影响 DSS 的一个高度显著的预测因子，在竞争风险模型中进行了分析（p=0.001）。
对于高位骨盆 CS，获得广泛的骨盆边缘仍然具有挑战性。基于我们的研究，我们得出结论，对于高位骨盆 CS 患者，为了获得最佳的肿瘤学结果，有必要获得至少 2mm 的切缘。
