Freund Michael R, Emile Sameh Hany, Horesh Nir, Garoufalia Zoe, Gefen Rachel, Wexner Steven D
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt.
Eur J Surg Oncol. 2023 Mar;49(3):647-654. doi: 10.1016/j.ejso.2022.10.014. Epub 2022 Oct 20.
Rectal sarcomas (RS) are rare malignant tumors with a very poor prognosis. This study aimed to assess the characteristics, treatment, and outcomes of RS in the United States.
This study was a retrospective analysis of the National Cancer Database (NCDB) from 2004 to 2019 of patients with a diagnosis of RS. The main outcome measures were overall survival (OS) and its predictors.
133 RS patients (39.1% female) with a mean age of 65.7 ± 15.6 years were included in the study. Mean tumor size was 6.1 ± 3 cm. The crude OS rate was 22.5% and median survival duration was 10.1 (IQR: 3.2-21) months. Factors associated with an improved OS on were private insurance (HR = 0.23, p = 0.001) and undergoing surgery (HR 0.23, p < 0.001), Factors associated with poor survival were age (HR 1.02, p = 0.005), male sex (HR 2.27, p = 0.001), Charlson score of 3 (HR 5.17, p = 0.003), and positive resection margins (HR: 2.64, p = 0.01). Multivariate Cox regression analysis revealed that male sex (HR 2.16, p = 0.04) and positive resection margins (HR 2.31, p = 0.03) were predictors of poor survival whereas surgery was an independent predictor of improved OS (HR 0.321, p < 0.001) CONCLUSIONS: RS is a very rare rectal malignancy with an even poorer prognosis than previously reported. However, undergoing surgery with curative intent while obtaining negative margins may confer better OS.
直肠肉瘤（RS）是一种罕见的恶性肿瘤，预后极差。本研究旨在评估美国直肠肉瘤的特征、治疗方法及预后。
本研究是对2004年至2019年国家癌症数据库（NCDB）中诊断为直肠肉瘤的患者进行的回顾性分析。主要观察指标为总生存期（OS）及其预测因素。
本研究纳入了133例直肠肉瘤患者（女性占39.1%），平均年龄为65.7±15.6岁。平均肿瘤大小为6.1±3厘米。总生存率粗率为22.5%，中位生存时间为10.1（四分位间距：3.2 - 21）个月。与总生存期改善相关的因素是私人保险（风险比[HR]=0.23，p = 0.001）和接受手术（HR 0.23，p < 0.001），与生存不良相关的因素是年龄（HR 1.02，p = 0.005）、男性（HR 2.27，p = 0.001）、查尔森评分为3（HR 5.17，p = 0.003）以及手术切缘阳性（HR：2.64，p = 0.01）。多因素Cox回归分析显示，男性（HR 2.16，p = 0.04）和手术切缘阳性（HR 2.31，p = 0.03）是生存不良的预测因素，而手术是总生存期改善的独立预测因素（HR 0.321，p < 0.001）。结论：直肠肉瘤是一种非常罕见的直肠恶性肿瘤，预后比先前报道的更差。然而，进行根治性手术并获得阴性切缘可能带来更好的总生存期。
