Takemori Toshiyuki, Kawamoto Teruya, Hara Hitomi, Fukase Naomasa, Fujiwara Shuichi, Kitayama Kazumichi, Yahiro Shunsuke, Miyamoto Tomohiro, Mifune Yutaka, Hoshino Yuichi, Kakutani Kenichiro, Matsumoto Tomoyuki, Matsushita Takehiko, Niikura Takahiro, Kuroda Ryosuke, Akisue Toshihiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Orthopaedic Surgery, Kobe University Hospital International Clinical Cancer Research Center, Kobe, Japan.
Cancer Manag Res. 2022 May 25;14:1815-1824. doi: 10.2147/CMAR.S364912. eCollection 2022.
Soft tissue sarcomas (STSs) constitute a group of rare, heterogeneous tumors representing approximately 1% of all cancers. Owing to the rarity and pathological diversity of the disease, unplanned excision (UE) has often been performed for STS, resulting in an unfavorable prognosis. This study aimed to clarify clinical outcomes and prognostic factors in STS patients who underwent UE.
In a retrospective review of the medical records of patients with STS who underwent surgery at our institution between 1999 and 2015, patients were enrolled to either a UE group or a planned excision (PE) group. An analysis was then conducted to identify factors associated with prognosis after UE.
Of 134 patients undergoing surgery for STS, 110 were enrolled to the PE group and 24 to the UE group. The median size of the primary tumor was significantly smaller, and more lesions were located in the superficial layer in the UE group than in the PE group. In addition, plastic reconstruction after additional radical resection was required significantly more often in the UE group than in the PE group. No significant difference in overall survival, local recurrence-free survival, or disease-free survival (DFS) between the UE and PE groups was observed; however, metastasis-free survival was significantly better in the UE group. In the UE group, poorer DFS was associated with older age (≥61 years) and a larger primary tumor (≥2.9 cm).
A prognosis similar to that in patients undergoing PE could be achieved by appropriate additional surgeries in patients initially undergoing UE. However, UE for STS should be avoided, especially in older patients and those with a larger primary tumor.
软组织肉瘤（STS）是一组罕见的异质性肿瘤，约占所有癌症的1%。由于该疾病的罕见性和病理多样性，STS常常进行了计划外切除（UE），导致预后不良。本研究旨在阐明接受UE的STS患者的临床结局和预后因素。
回顾性分析1999年至2015年间在本机构接受手术的STS患者的病历，将患者纳入UE组或计划切除（PE）组。然后进行分析以确定与UE后预后相关的因素。
134例接受STS手术的患者中，110例纳入PE组，24例纳入UE组。UE组原发肿瘤的中位大小明显较小，且位于表层的病变比PE组更多。此外，UE组比PE组更频繁地需要在额外根治性切除后进行整形重建。UE组和PE组在总生存期、无局部复发生存期或无病生存期（DFS）方面未观察到显著差异；然而，UE组的无转移生存期明显更好。在UE组中，较差的DFS与年龄较大（≥61岁）和原发肿瘤较大（≥2.9 cm）相关。
对于最初接受UE的患者，通过适当的额外手术可以实现与接受PE的患者相似的预后。然而，应避免对STS进行UE，尤其是在老年患者和原发肿瘤较大的患者中。
