Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Curr Oncol. 2022 Sep 14;29(9):6540-6550. doi: 10.3390/curroncol29090514.
Soft tissue sarcomas (STS) invading the skull base are rare with little data to guide surgical management. Here we aimed to determine the factors affecting tumor control rates and survival in patients with T4 stage head and neck STS involving the skull base. A retrospective review of STS patients, surgically treated at our institution between 1994 and 2017 was conducted. Variables were collected and assessed against progression-free survival. Tumors were graded using the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) system. A total of 51 patients (mean age of 35) were included, of whom 17 (33.3%) patients were FNCLCC grade 1, 8 (15. 7%) were FNCLCC grade 2 and 26 (51%) were FNCLCC grade 3. The median PFS was 236.4 months while the 5- and 10-year PFS rates were 44% and 17%, respectively. Recurrence occurred in 17 (33.3%) patients. Local recurrence occurred in 10 (58.8%). Univariate analysis revealed R0 resection had a near-significant impact on tumor control in radiation-naïve patients. Otherwise, prior radiation (HR 6.221, CI 1.236-31.314) and cavernous sinus involvement (HR 14.464, CI 3.326-62.901) were negative predictors of PFS. The most common cause of treatment failure was local recurrence. In T4 stage head and neck STS with skull-base involvement, FNCLCC grade, radiation status, and anatomic spread should be considered in determining the overall treatment strategy.
软组织肉瘤（STS）侵犯颅底罕见，手术治疗的相关数据较少。本研究旨在确定影响颅底侵犯的 T4 期头颈部 STS 患者肿瘤控制率和生存率的因素。对 1994 年至 2017 年在我院接受手术治疗的 STS 患者进行回顾性研究。收集变量并评估其与无进展生存率的相关性。肿瘤分级采用法国抗癌协会（FNCLCC）系统。共纳入 51 例患者（平均年龄 35 岁），其中 17 例（33.3%）为 FNCLCC 1 级，8 例（15.7%）为 FNCLCC 2 级，26 例（51%）为 FNCLCC 3 级。中位 PFS 为 236.4 个月，5 年和 10 年 PFS 率分别为 44%和 17%。17 例（33.3%）患者出现复发，其中 10 例（58.8%）为局部复发。单因素分析显示，在未行放疗的患者中，R0 切除对肿瘤控制有显著影响。而在接受过放疗的患者中，放疗（HR 6.221，CI 1.236-31.314）和海绵窦受累（HR 14.464，CI 3.326-62.901）是 PFS 的负预测因素。治疗失败的最常见原因是局部复发。对于颅底侵犯的 T4 期头颈部 STS，FNCLCC 分级、放疗状态和解剖扩散应作为决定整体治疗策略的因素。
