评估一种新的分类系统，以预测接受半骨盆切除术和髂骶切除术的肉瘤患者的局部复发情况。
Evaluation of a novel classification system to predict local recurrence in sarcoma patients undergoing hemipelvectomy with iliosacral resection.
机构信息
Department of General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany.
Gerhard-Domagk-Institut of Pathology, Münster University Hospital, Münster, Germany.
出版信息
Bone Joint J. 2022 Feb;104-B(2):290-296. doi: 10.1302/0301-620X.104B2.BJJ-2021-1180.R1.
AIMS
Iliosacral sarcoma resections have been shown to have high rates of local recurrence (LR) and poor overall survival. There is also no universal classification for the resection of pelvic sarcomas invading the sacrum. This study proposes a novel classification system and analyzes the survival and risk of recurrence, when using this system.
METHODS
This is a retrospective analysis of 151 patients (with median follow-up in survivors of 44 months (interquartile range 12 to 77)) who underwent hemipelvectomy with iliosacral resection at a single centre between 2007 and 2019. The proposed classification differentiates the extent of iliosacral resection and defines types S1 to S6 (S1 resection medial and parallel to the sacroiliac joint, S2 resection through the ipsilateral sacral lateral mass to the neuroforamina, S3 resection through the ipsilateral neuroforamina, S4 resection through ipsilateral the spinal canal, and S5 and S6 contralateral sacral resections). Descriptive statistics and the chi-squared test were used for categorical variables, and the Kaplan-Meier survival analysis were performed.
RESULTS
Resections were S1 in 25/151 patients (17%), S2 in 70/151 (46%), S3 in 33/151 (22%), S4 in 77/151 (11%), S5 in 4/151 (3%), and S6 in 2/151 (1%). An internal hemipelvectomy was performed in 113/151 patients (75%), and 38/151 patients (25%) had an external hemipelvectomy. The predominant types of sarcoma were high-grade osteosarcoma in 48/151 patients (32%), chondrosarcoma in 41/151 (27%), Ewing sarcoma in 33/151 (22%), pleomorphic sarcoma in 17/151 (11%), and others in 2/151 (8%). LR was found in 24/151 patients (15%) with S3, S5, with S6 resections showing the highest rate of LR (p = 0.038). Overall, 19/151 patients (16%) had evidence of metastastic disease at the time of surgery and these patients showed poorer survival when compared to patients with no metastasis.
CONCLUSION
The proposed classification can help to report and compare different surgical and reconstructive approaches in these difficult cases who are still have a considerable risk of LR. Cite this article: 2022;104-B(2):290-296.
目的
骨盆肉瘤侵犯骶骨时，其切除术的局部复发率（LR）较高，整体存活率较差。目前对于骶骨切除术还没有普遍的分类。本研究提出了一种新的分类系统，并分析了使用该系统时的生存率和复发风险。
方法
这是对 2007 年至 2019 年间在一家中心接受半骨盆切除术伴髂骨骶骨切除术的 151 例患者（中位随访时间为幸存者 44 个月（四分位距 12 至 77））的回顾性分析。所提出的分类区分了髂骨骶骨切除的范围，并定义了 S1 至 S6 型（S1 切除内侧并与骶髂关节平行，S2 切除同侧骶骨外侧块至神经孔，S3 切除同侧神经孔，S4 切除同侧椎管，S5 和 S6 对侧骶骨切除）。使用描述性统计和卡方检验进行分类变量，使用 Kaplan-Meier 生存分析。
结果
151 例患者中，S1 切除术 25 例（17%），S2 切除术 70 例（46%），S3 切除术 33 例（22%），S4 切除术 77 例（11%），S5 切除术 4 例（3%），S6 切除术 2 例（1%）。151 例患者中有 113 例（75%）行内半骨盆切除术，38 例（25%）行外半骨盆切除术。主要的肉瘤类型为 48 例（32%）高级别骨肉瘤、41 例（27%）软骨肉瘤、33 例（22%）尤文肉瘤、17 例（11%）多形性肉瘤和 2 例（8%）其他肉瘤。151 例患者中有 24 例（15%）出现 LR，S3、S5 切除的 LR 发生率最高（p = 0.038）。总体而言，19 例（16%）患者在手术时已有转移病灶，与无转移病灶的患者相比，这些患者的生存率较差。
结论
该分类方法有助于报告和比较这些困难病例中不同的手术和重建方法，这些患者仍然有相当高的 LR 风险。
引用本文
2022;104-B（2）：290-296。
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