Zastrow Ryley K, El Sayed Mohyeddine, LiBrizzi Christa L, Jacobs Andrew J, Levin Adam S
Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
American University of Beirut, Beirut, Lebanon.
Sarcoma. 2024 Feb 19;2024:8880609. doi: 10.1155/2024/8880609. eCollection 2024.
Extremity soft-tissue sarcoma (ESTS) is a group of rare, heterogeneous malignancies. Previous studies have demonstrated a progressive improvement in 5-year survival rate over time, but recent trends are unknown. Therefore, this study aimed to provide an update on the clinical characteristics and 5-year survival rate of ESTS from 1999 to 2019.
This retrospective cohort study used the Surveillance, Epidemiology, and End Results (SEER) database. Overall, 5,654 patients over the age of 15 years with primary ESTS diagnosed between 1999 and 2019 were included. Data on patient demographics, clinical characteristics, and survival were extracted. Patients were grouped by year of diagnosis: 1999-2005, 2006-2012, and 2013-2019. Kaplan-Meier and Cox proportional hazards regression analyses were performed.
ESTS occurred primarily in the lower extremity (76.1%) and was frequently grade III (58.3%), >5 cm in size (69.9%), and without metastasis (77.9%) at diagnosis. Furthermore, there was a significant increase in the proportion of patients over age 60 ( < 0.001) and without metastasis ( < 0.001) over the study period. The 5-year survival rate successively improved, from 47% in 1999-2005, to 61% in 2006-2012, to 78% in 2013-2019. Similarly, in multivariate analysis, the mortality rate progressively declined from a hazard ratio (HR) of 3.4 in 1999-2005 to an HR of 2.1 in 2006-2012, with the 2013-2019 group having the best overall survival ( < 0.001). Age, tumor size, grade, and metastasis were negative prognostic factors for survival; radiation and surgery were positive prognostic factors.
The 5-year overall survival rate for ESTS progressively improved over the 20-year study period, perhaps due to an increasing proportion of older patients diagnosed with local disease. These findings may also be related to earlier detection or more effective treatment over the study period.
肢体软组织肉瘤（ESTS）是一组罕见的、异质性恶性肿瘤。既往研究表明，5年生存率随时间逐步提高，但近期趋势尚不清楚。因此，本研究旨在更新1999年至2019年ESTS的临床特征和5年生存率。
这项回顾性队列研究使用了监测、流行病学和最终结果（SEER）数据库。总共纳入了1999年至2019年间诊断为原发性ESTS的5654例15岁以上患者。提取了患者人口统计学、临床特征和生存数据。患者按诊断年份分组：1999 - 2005年、2006 - 2012年和2013 - 2019年。进行了Kaplan-Meier和Cox比例风险回归分析。
ESTS主要发生在下肢（76.1%），诊断时多为Ⅲ级（58.3%），肿瘤大小>5 cm（69.9%），无转移（77.9%）。此外，在研究期间，60岁以上患者（<0.001）和无转移患者（<0.001）的比例显著增加。5年生存率依次提高，从1999 - 2005年的47%提高到2006 - 2012年的61%，再到2013 - 2019年的78%。同样，在多变量分析中，死亡率从1999 - 2005年的风险比（HR）3.4逐渐下降到2006 - 2012年的HR 2.1，2013 - 2019年组的总体生存率最佳（<0.001）。年龄、肿瘤大小、分级和转移是生存的负性预后因素；放疗和手术是正性预后因素。
在20年的研究期间，ESTS的5年总生存率逐步提高，这可能是由于诊断为局部疾病的老年患者比例增加。这些发现也可能与研究期间更早的检测或更有效的治疗有关。
