Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan;
Laboratory of Oncogenomics, Chiba Cancer Center Research Institute, Chiba, Japan.
Anticancer Res. 2023 Jul;43(7):3273-3279. doi: 10.21873/anticanres.16502.
BACKGROUND/AIM: Malignant bone tumors (MBT) and soft tissue sarcomas (STS) require wide excision. Although the number of elderly patients is increasing, wide excision may decrease limb function and quality of life (QOL) for elderly patients. However, no detailed evaluation of the functional prognosis or QOL of elderly patients with sarcoma has been reported. This study evaluated postoperative limb function and QOL in elderly patients with MBT and STS.
This retrospective study included 67 patients aged >70 years with MBT or STS who underwent surgery at a single institution. The Toronto Extremity Salvage Score (TESS), EuroQoL 5-dimension 5-level (EQ-5D-5L) questionnaire, Musculoskeletal Tumor Society (MSTS) score, and psoas muscle index (PMI) were evaluated. We also assessed factors associated with the postoperative TESS and EQ-5D-5L index.
Detailed examination of the MSTS items perioperatively revealed significant decline in manual dexterity/walking ability and support but significant improvement in pain and emotional acceptance. The mean PMI decreased significantly from 4.7 to 4.23 perioperatively. The postoperative mean TESS and EQ-5D-5L index was 76.9 and 0.74, respectively. Patients with good performance status and clinical frailty scale scores preoperatively had better postoperative TESS and EQ-5D-5L scores.
The current study strongly suggests the possibility of maintaining postoperative limb function, satisfaction, and QOL in patients with MBT and STS by choosing patients in good condition and the appropriate procedure that the patient desires. However, perioperative progression of sarcopenia should be noted.
背景/目的：恶性骨肿瘤（MBT）和软组织肉瘤（STS）需要广泛切除。尽管老年患者的数量在增加，但广泛切除可能会降低老年患者的肢体功能和生活质量（QOL）。然而，目前尚未有详细评估老年肉瘤患者的功能预后或 QOL 的报道。本研究评估了老年 MBT 和 STS 患者的术后肢体功能和 QOL。
本回顾性研究纳入了在单家机构接受手术治疗的 67 名年龄>70 岁的 MBT 或 STS 患者。采用多伦多肢体挽救评分（TESS）、欧洲五维健康量表 5 维度 5 级（EQ-5D-5L）问卷、肌肉骨骼肿瘤学会（MSTS）评分和腰大肌指数（PMI）进行评估。我们还评估了与术后 TESS 和 EQ-5D-5L 指数相关的因素。
对 MSTS 项目的详细术前和术后检查显示，手的灵巧度/行走能力和支撑力显著下降，但疼痛和情绪接受度显著改善。PMI 均值从术前的 4.7 显著下降到术后的 4.23。术后 TESS 和 EQ-5D-5L 指数的均值分别为 76.9 和 0.74。术前体能状态和临床虚弱量表评分良好的患者术后 TESS 和 EQ-5D-5L 评分更好。
本研究强烈表明，通过选择身体状况良好的患者和患者期望的合适手术方式，有可能维持 MBT 和 STS 患者的术后肢体功能、满意度和 QOL。然而，应注意围手术期肌少症的进展。
