肢体肉瘤的截肢术：适应症与预后

Amputation for Extremity Sarcoma: Indications and Outcomes.

作者信息

Kirilova Maya, Klein Alexander, Lindner Lars H, Nachbichler Silke, Knösel Thomas, Birkenmaier Christof, Baur-Melnyk Andrea, Dürr Hans Roland

机构信息

Musculoskeletal Oncology, Department of Orthopaedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-University Munich, D-81377 Munich, Germany.

SarKUM, Center of Bone and Soft Tissue Tumors, University Hospital, Ludwig-Maximilians-University Munich, D-81377 Munich, Germany.

出版信息

Cancers (Basel). 2021 Oct 13;13(20):5125. doi: 10.3390/cancers13205125.

BACKGROUND

Sarcomas are rare, malignant tumors of soft tissues or bone. Limb salvage surgery (LSS) is the standard treatment, but amputation is still an option, especially in local recurrence or complications after LSS.

METHODS

We retrospectively reviewed indications and oncological outcomes in patients who underwent an amputation. Two groups with either primary amputations ( = 120) or with secondary amputations after failed LSS with local recurrence or complications ( = 29) were compared with the main end points of LRFS and OS.

RESULTS

Five-year LRFS was 84% with 17 (16%) patients developing local recurrence, of which 16 (13%) occurred in group I. Forty-two (28%) patients developed metastatic disease and overall survival at five years was 44%. Overall survival (OS) was the same in both groups. In those group II patients who had a secondary amputation due to LR or insufficient margins after LSS ( = 12) the five-year OS was 33% compared to 48% in patients with amputation due to complications ( = 17) (n.s.).

CONCLUSIONS

This study indicates the worse oncological outcomes with respect to OS of sarcoma patients requiring an amputation as compared to LSS. Patients with primary amputation or those who had a secondary amputation after failed LSS for whatever reason showed the same oncological results.

背景

肉瘤是软组织或骨的罕见恶性肿瘤。保肢手术（LSS）是标准治疗方法，但截肢仍是一种选择，尤其是在LSS后的局部复发或并发症情况下。

方法

我们回顾性分析了接受截肢手术患者的指征和肿瘤学结局。将两组患者进行比较，一组为初次截肢（n = 120），另一组为LSS失败后因局部复发或并发症而进行二次截肢（n = 29），主要终点为局部复发无进展生存期（LRFS）和总生存期（OS）。

结果

5年LRFS为84%，17例（16%）患者出现局部复发，其中16例（13%）发生在第一组。42例（28%）患者发生转移性疾病，5年总生存率为44%。两组的总生存期（OS）相同。在因LSS后局部复发或切缘不足而进行二次截肢的第二组患者中（n = 12），5年OS为33%，而因并发症进行截肢的患者中（n = 17）为48%（无统计学差异）。