患者行再次手术治疗孤立性纤维肿瘤/血管外皮细胞瘤和肿瘤恶性进展的临床结局。
Clinical outcomes of patients undergoing reoperation with solitary fibrous tumors/hemangiopericytomas and malignant progression of tumors.
机构信息
Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, Xi'an, 710038, China.
Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force, Wu xi, China.
出版信息
Neurosurg Rev. 2024 Oct 10;47(1):773. doi: 10.1007/s10143-024-02956-2.
OBJECTIVE
The purpose of this study was to analyze the clinical outcomes and malignant progression of tumors in patients who underwent reoperation for recurrent solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs).
METHODS
We identified 48 patients who underwent reoperation because of tumor recurrence at Tangdu Hospital between January 2010 and December 2021 and analyzed the clinical outcomes, namely, the rate of gross total resection (GTR), progression-free survival (PFS), overall survival (OS), malignant progression of tumors and radiotherapy. The survival curves for each group were plotted using the Kaplan‒Meier method and compared using log-rank tests.
RESULTS
Of the 48 patients (25 men and 23 women, mean age 49.5 ± 14.3 years), 25 experienced a second recurrence or metastasis, 15 of whom underwent a third surgery, and the remaining 10 patients who did not undergo surgery ultimately died after tumor progression. The median time (95% CI) to tumor recurrence was 40.0 (32.3-47.7) months after reoperation, with 3-, 5- and 10-year PFS rates of 54.6%, 29.5% and 14.8%, respectively. The median (95% CI) survival time was 70.0 (46.6-93.4) months, with 3-, 5- and 10-year survival rates of 67.9%, 55.1% and 36.7%, respectively. Among the 48 patients who underwent reoperation, 27 (56.3%) achieved GTR, and 21 (43.8%) achieved STR. Twelve patients in the GTR group (12/27, 44.4%) received radiotherapy after surgery, and 18 patients in the STR group (18/21, 85.7%) received radiotherapy. Of the 48 recurrent SFTs, 24 were classified as WHO grade 1, 14 were classified as WHO grade 2, and 10 were classified as WHO grade 3 based on 2021 WHO classification after the primary operation. After reoperation, 9 tumors developed malignant progression, including 4 WHO grade 1 tumors progressing to WHO grade 2 tumors, 1 WHO grade 1 tumor progressing to a WHO grade 3 tumor and 4 WHO grade 2 tumors progressing to WHO grade 3 tumors.
CONCLUSIONS
GTR after reoperation was associated with better PFS and OS compared to STR. However, the PFS after the third surgery was significantly shorter than that after the second surgery, and the rate of GTR also decreased. Malignant progression may occur after second or third tumor recurrence. Furthermore, compared with WHO grade 1 SFTs, WHO grade 2 and grade 3 SFTs significantly decreased PFS, but OS did not differ among the three groups. Radiotherapy did not prolong PFS or OS in patients who underwent reoperation.
目的
本研究旨在分析因复发性孤立性纤维瘤（SFT）和血管外皮细胞瘤（HPC）而再次手术的患者的临床结局和肿瘤恶性进展情况。
方法
我们在 2010 年 1 月至 2021 年 12 月期间在唐都医院共识别出 48 名因肿瘤复发而再次手术的患者，并分析了临床结局，即大体全切除（GTR）率、无进展生存期（PFS）、总生存期（OS）、肿瘤恶性进展和放疗。使用 Kaplan-Meier 法绘制各组的生存曲线，并使用对数秩检验进行比较。
结果
在 48 名患者（25 名男性和 23 名女性，平均年龄 49.5±14.3 岁）中，25 名患者出现第二次复发或转移，其中 15 名患者进行了第三次手术，而其余 10 名未手术的患者最终因肿瘤进展而死亡。再次手术后肿瘤复发的中位时间（95%CI）为 40.0（32.3-47.7）个月，3、5 和 10 年的 PFS 率分别为 54.6%、29.5%和 14.8%。中位（95%CI）生存时间为 70.0（46.6-93.4）个月，3、5 和 10 年的生存率分别为 67.9%、55.1%和 36.7%。在再次手术的 48 名患者中，27 名（56.3%）达到 GTR，21 名（43.8%）达到次全切除（STR）。GTR 组的 12 名患者（12/27，44.4%）在手术后接受了放疗，STR 组的 18 名患者（18/21，85.7%）接受了放疗。在 48 例复发性 SFT 中，根据 2021 年 WHO 分类，有 24 例为 WHO 1 级，14 例为 WHO 2 级，10 例为 WHO 3 级。在再次手术后，有 9 个肿瘤发生恶性进展，包括 4 个 WHO 1 级肿瘤进展为 WHO 2 级肿瘤，1 个 WHO 1 级肿瘤进展为 WHO 3 级肿瘤，和 4 个 WHO 2 级肿瘤进展为 WHO 3 级肿瘤。
结论
与 STR 相比，再次手术后的 GTR 与更好的 PFS 和 OS 相关。然而，第三次手术后的 PFS 明显短于第二次手术后，GTR 率也降低。第二次或第三次肿瘤复发后可能发生恶性进展。此外，与 WHO 1 级 SFT 相比，WHO 2 级和 3 级 SFT 明显降低了 PFS，但三组的 OS 没有差异。放疗并没有延长再次手术后患者的 PFS 或 OS。
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