291 例头颈部肉瘤患者的回顾性研究：治疗、结果和预后因素。

A Retrospective Study of 291 Patients With Head and Neck Sarcomas: Treatment, Outcomes, and Prognostic Factors.

机构信息

Faculty of Health, Aarhus University, Vennelyst Boulevard 4 8000 Aarhus C, Denmark.

Faculty of Health, Aarhus University, Vennelyst Boulevard 4 8000 Aarhus C, Denmark; Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 8200 Aarhus N, Denmark.

出版信息

Clin Oncol (R Coll Radiol). 2024 Jul;36(7):409-419. doi: 10.1016/j.clon.2024.04.009. Epub 2024 Apr 27.

DOI:10.1016/j.clon.2024.04.009

PMID:38744596

Abstract

AIMS

Sarcomas constitute a group of rare malignant neoplasms, commonly subcategorized into soft tissue sarcomas (STS) and bone sarcomas. This study aims to describe the treatment modalities and outcome of head and neck sarcoma (HNS) patients in western Denmark and to identify prognostic factors for overall survival and recurrence in HNS patients.

MATERIALS AND METHODS

The Aarhus sarcoma registry, The National Danish Sarcoma Database, and the Danish National Pathology Registry were used to identify HNS adult patients diagnosed between 1979 and 2022.

RESULTS

Altogether, 291 patients were included in this study. The prevalent histological subtypes were undifferentiated pleomorphic sarcoma (16%; 48/291) and leiomyosarcoma (15%; 44/291) for STS patients (n = 230) and chondrosarcoma (10%; 28/291) and osteosarcoma (7%; 19/291) for bone sarcoma patients (n = 61). Surgery with curative intent was performed in 71% (164/230) and 70% (43/61) of STS and bone sarcoma patients, respectively. Clear resection was achieved in 59% (97/164) of STS patients and 44% (19/43) of bone sarcoma patients. Eighty-nine patients relapsed (STS n = 66, bone sarcoma n = 23) after a median time of 2.7/5.5 years for STS/bone sarcoma patients. The five-year overall survival rates were 45% for STS patients and 66% for bone sarcoma patients. The following factors were significantly, negatively associated with overall survival in STS patients: Age (hazard ratio (HR)) = 1.02, p < 0.001), tumour size ≥5 cm (HR = 1.75, p = 0.003), metastatic disease (HR = 3.17, p < 0.001), high grade tumour (HR = 2.24, p = 0.004), previous cancer (HR = 2.84, p < 0.001), and high Aarhus composite biomarker score (ACBS) (HR = 4.56, p = 0.001). For relapse in STS patients, higher tumour grade (HR = 3.19, p = 0.014), intralesional margins (HR = 2.84, p < 0.001), ≥2 previous cancers (HR = 3.00, p = 0.004), and high ACBS (HR = 3.29, p = 0.047), were negatively associated. For bone sarcomas only higher age (HR = 1.02, p = 0.049) and intralesional margins (HR = 2.91, p = 0.042) were significant negative factors for overall survival.

CONCLUSION

Multiple prognostic factors for overall survival and relapse were identified, especially for STS patients.

摘要

目的

肉瘤是一组罕见的恶性肿瘤，通常分为软组织肉瘤（STS）和骨肉瘤。本研究旨在描述丹麦西部头颈部肉瘤（HNS）患者的治疗方式和结果，并确定 HNS 患者总生存和复发的预后因素。

材料和方法

使用奥胡斯肉瘤登记处、丹麦国家肉瘤数据库和丹麦国家病理学登记处，确定 1979 年至 2022 年间诊断为 HNS 的成年患者。

结果

共有 291 名患者纳入本研究。STS 患者（n=230）中常见的组织学亚型为未分化多形性肉瘤（16%；48/230）和平滑肌肉瘤（15%；44/230），骨肉瘤患者（n=61）中常见的组织学亚型为软骨肉瘤（10%；28/230）和骨肉瘤（7%；19/230）。STS 和骨肉瘤患者分别有 71%（164/230）和 70%（43/61）进行了以治愈为目的的手术。59%（97/164）的 STS 患者和 44%（19/43）的骨肉瘤患者达到了完全切除。中位时间为 2.7/5.5 年后，89 名患者（STS n=66，骨肉瘤 n=23）复发。STS 患者的五年总生存率为 45%，骨肉瘤患者为 66%。以下因素与 STS 患者的总生存显著负相关：年龄（风险比（HR）=1.02，p<0.001），肿瘤大小≥5cm（HR=1.75，p=0.003），转移性疾病（HR=3.17，p<0.001），高级别肿瘤（HR=2.24，p=0.004），既往癌症（HR=2.84，p<0.001）和高奥胡斯综合生物标志物评分（ACBS）（HR=4.56，p=0.001）。对于 STS 患者的复发，更高的肿瘤分级（HR=3.19，p=0.014）、腔内边缘（HR=2.84，p<0.001）、≥2 次既往癌症（HR=3.00，p=0.004）和高 ACBS（HR=3.29，p=0.047）与负相关。对于骨肉瘤，仅年龄较大（HR=1.02，p=0.049）和腔内边缘（HR=2.91，p=0.042）是总生存的显著负相关因素。