Elmorsi Rami, Camacho Luis, Krijgh David D, Tilney Gordon S, Lyu Heather, Traweek Raymond S, Witt Russell G, Roubaud Margaret S, Roland Christina L, Mericli Alexander F
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Ann Surg Oncol. 2024 Aug;31(8):5421-5430. doi: 10.1245/s10434-024-15183-2. Epub 2024 Mar 23.
Limb-sparing resections of thigh soft tissue sarcomas (STSs) can result in adverse outcomes. Identifying preoperative predictors for wound healing complications, tumor recurrence, and mortality is crucial for informed reconstructive decision-making. We hypothesized that preoperative measurements of thigh and tumor dimensions could serve as reliable indicators for postoperative complications, recurrence, and death.
In this retrospective cohort study conducted from March 2016 to December 2021, we analyzed patients undergoing thigh STS excisions followed by reconstruction. Preoperative magnetic resonance imaging or computed tomography scans provided necessary thigh and tumor dimensions. Univariate and multivariate regression assessed relationships between these dimensions and postoperative outcomes, including complications, recurrence, and death.
Upon the analysis of 123 thighs, we found thigh width to be highly predictive of postoperative complications, even surpassing body mass index (BMI) and retaining significance in multivariate regression [odds ratio (OR) 1.19; 95% CI 1.03-1.39; p = 0.03]. Sarcoma-to-thigh width and thickness ratios predicted STS recurrence, with the thickness ratio retaining significance in multivariate regression (OR 1.03; 95% CI 1.001-1.05; p = 0.041). Notably, greater thigh thickness was independently protective against mortality in multivariate analysis (OR 0.80; 95% CI 0.65-0.98; p = 0.030).
Thigh width outperformed BMI in association with postoperative complications. This may create an opportunity for intervention, where weight loss can play a role during the neoadjuvant therapy period to potentially reduce complications. Sarcoma-to-thigh width and thickness ratios, particularly the latter, hold substantial predictive value in terms of STS recurrence. Moreover, thigh thickness is an independent predictor of survival.
大腿软组织肉瘤（STS）的保肢切除术可能导致不良后果。识别伤口愈合并发症、肿瘤复发和死亡率的术前预测因素对于明智的重建决策至关重要。我们假设大腿和肿瘤尺寸的术前测量可以作为术后并发症、复发和死亡的可靠指标。
在这项从2016年3月至2021年12月进行的回顾性队列研究中，我们分析了接受大腿STS切除并随后进行重建的患者。术前磁共振成像或计算机断层扫描提供了必要的大腿和肿瘤尺寸。单因素和多因素回归评估了这些尺寸与术后结果之间的关系，包括并发症、复发和死亡。
在分析123条大腿后，我们发现大腿宽度对术后并发症具有高度预测性，甚至超过体重指数（BMI），并且在多因素回归中仍具有显著性[比值比（OR）1.19；95%置信区间1.03 - 1.39；p = 0.03]。肉瘤与大腿宽度和厚度的比值可预测STS复发，厚度比值在多因素回归中仍具有显著性（OR 1.03；95%置信区间1.001 - 1.05；p = 0.041）。值得注意的是，在多因素分析中，更大的大腿厚度对死亡率具有独立的保护作用（OR 0.80；95%置信区间0.65 - 0.98；p = 0.030）。
与术后并发症相关时，大腿宽度比BMI表现更优。这可能创造了一个干预机会，即减重可在新辅助治疗期间发挥作用，以潜在降低并发症。肉瘤与大腿宽度和厚度比值，尤其是后者，在STS复发方面具有重要预测价值。此外大腿厚度是生存的独立预测因素。
