Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA Netw Open. 2024 Sep 3;7(9):e2431530. doi: 10.1001/jamanetworkopen.2024.31530.
Improved prognostic tools are needed for patients with locally recurrent extremity or truncal soft tissue sarcoma (STS).
To examine the association between average local recurrence (LR) growth rate and outcomes following resection of locally recurrent extremity or truncal STS.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a prospectively maintained database from a single high-volume tertiary sarcoma referral center in the US to identify patients 16 years of age or older who underwent repeat resection of a locally recurrent extremity or truncal STS between July 1, 1982, and December 31, 2021. Patients with atypical lipomatous tumors, desmoid tumors, dermatofibrosarcoma protuberans, angiosarcomas, and prior or synchronous distant recurrence were excluded. Data were analyzed from November 1, 2022, to June 17, 2024.
Average LR growth rate, defined as the sum of recurrent tumor maximal diameters divided by the disease-free interval after index operation.
The primary outcomes were cumulative incidences of disease-specific death (DSD), with death from other causes as a competing risk, and second LR, with death from any cause as a competing risk.
The study cohort included 253 patients (median [IQR] age, 64 [51-73] years; 140 [55.3%] male). The 5-year cumulative incidence of DSD after repeat resection was 29%. Multivariable analysis indicated that LR growth rate (hazard ratio [HR], 1.12 [95% CI, 1.08-1.18]; P < .001), younger age (HR, 0.98 [95% CI, 0.97-0.99]; P = .002), R1 or R2 margins (HR, 1.71 [95% CI, 1.03-2.84]; P = .04), high LR grade (HR, 2.90 [95% CI, 1.17-7.20]; P = .02), and multifocality (HR, 2.92 [95% CI, 1.70-5.00]; P < .001) were independently associated with higher incidence of DSD. Using the minimum P value method, the optimal cutoff for growth rate was found to be 0.68 cm/mo. Patients with values above this cutoff had higher 5-year incidences of DSD following repeat resection (63% vs 19%; permutation test P < .001) and higher amputation rates (19% vs 7%; P = .008). Only R1 margins were independently associated with higher incidence of second LR (HR, 1.81 [95% CI, 1.19-2.78]; P = .006).
In this cohort study of patients undergoing resection of a locally recurrent extremity or truncal STS, LR growth rate was independently associated with DSD. These findings suggest that patients with growth rates higher than 0.68 cm/mo who undergo LR resection may have high disease-specific mortality and amputation rates and should be considered for perioperative systemic therapy.
对于局部复发性肢体或躯干软组织肉瘤（STS）患者，需要改进预后工具。
研究局部复发性肢体或躯干 STS 切除后平均局部复发（LR）生长率与结局的关系。
设计、地点和参与者：本回顾性队列研究使用美国一家高容量三级肉瘤转诊中心的前瞻性维护数据库，确定 1982 年 7 月 1 日至 2021 年 12 月 31 日期间接受局部复发性肢体或躯干 STS 重复切除术的年龄在 16 岁及以上的患者。排除非典型脂肪瘤肿瘤、硬纤维瘤、隆凸性皮肤纤维肉瘤、血管肉瘤和既往或同时远处复发的患者。数据于 2022 年 11 月 1 日至 2024 年 6 月 17 日进行分析。
平均 LR 生长率，定义为复发肿瘤最大直径之和除以指数手术后无病间隔。
主要结局是疾病特异性死亡（DSD）的累积发生率，以其他原因导致的死亡为竞争风险，以及第二次 LR，以任何原因导致的死亡为竞争风险。
该研究队列包括 253 名患者（中位数[IQR]年龄，64 [51-73]岁；140 [55.3%]为男性）。重复切除后 5 年 DSD 的累积发生率为 29%。多变量分析表明，LR 生长率（HR，1.12 [95%CI，1.08-1.18]；P<0.001）、年龄较小（HR，0.98 [95%CI，0.97-0.99]；P=0.002）、R1 或 R2 切缘（HR，1.71 [95%CI，1.03-2.84]；P=0.04）、高 LR 分级（HR，2.90 [95%CI，1.17-7.20]；P=0.02）和多发性（HR，2.92 [95%CI，1.70-5.00]；P<0.001）与更高的 DSD 发生率独立相关。使用最小 P 值法，发现生长率的最佳截断值为 0.68 cm/月。生长率超过该截值的患者在重复切除后 5 年 DSD 发生率更高（63% vs 19%；置换检验 P<0.001）和更高的截肢率（19% vs 7%；P=0.008）。只有 R1 切缘与较高的第二次 LR 发生率独立相关（HR，1.81 [95%CI，1.19-2.78]；P=0.006）。
在这项接受局部复发性肢体或躯干 STS 切除术的患者队列研究中，LR 生长率与 DSD 独立相关。这些发现表明，生长率高于 0.68 cm/月且接受 LR 切除术的患者可能具有较高的疾病特异性死亡率和截肢率，应考虑围手术期全身治疗。
