Nydegger Kim N, Obergfell Timothy T A F, Heesen Philip, Schelling Georg, Studer Gabriela, Bode-Lesniewska Beata, Fuchs Bruno
Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
Sarkomzentrum, Kliink für Orthopädie und Unfallchirurgie, LUKS University Hospital, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.
Cancers (Basel). 2024 Oct 7;16(19):3408. doi: 10.3390/cancers16193408.
Sarcomas, a diverse group of malignant tumors arising from mesenchymal tissues, pose significant diagnostic and therapeutic challenges. This study compares the outcomes of planned resections (PEs) and unplanned resections (UEs) to inform better clinical practices.
Data were analyzed from the Swiss Sarcoma Network (SSN), including patients with soft tissue and bone sarcomas treated at two major hospitals. This study utilized logistic regression and Cox regression models to examine the odds of UEs and their impact on local recurrence-free survival.
Among 429 patients registered by SSN members, 323 (75%) underwent PEs and 106 (25%) experienced UEs. PEs were associated with significantly larger tumors (94 mm vs. 47 mm, < 0.001) and higher-grade tumors (Grade 3: 50.5% vs. 37.4%, = 0.03). Despite achieving superior resection margins (R0: 78.8% vs. 12.6%, < 0.001), PEs showed higher metastasis rates at follow-up (31.0% vs. 10.4%, < 0.001) and greater cancer-specific mortality (16.7% vs. 6.6%, = 0.01). UEs, while linked to higher local recurrence, did not significantly affect metastasis-free survival (MFS) or overall survival (OS).
PEs achieve superior immediate surgical outcomes but are linked to higher metastasis and cancer-specific mortality due to the advanced stage of tumors. UEs, while associated with higher local recurrence rates, do not significantly impact MFS or OS. Early detection, comprehensive diagnostics, and timely referrals to specialized sarcoma hubs are essential to avoid UEs and reduce metastatic risk. Future research should focus on developing diagnostic tools using individual tumor and patient characteristics to improve sarcoma management.
肉瘤是一组起源于间充质组织的恶性肿瘤，在诊断和治疗上面临重大挑战。本研究比较了计划性切除（PE）和非计划性切除（UE）的结果，以优化临床实践。
分析了瑞士肉瘤网络（SSN）的数据，包括在两家主要医院接受治疗的软组织和骨肉瘤患者。本研究使用逻辑回归和Cox回归模型来研究UE的几率及其对无局部复发生存率的影响。
在SSN成员登记的429例患者中，323例（75%）接受了PE，106例（25%）经历了UE。PE与明显更大的肿瘤（94毫米对47毫米，<0.001）和更高分级的肿瘤（3级：50.5%对37.4%，=0.03）相关。尽管PE实现了更好的切缘（R0：78.8%对12.6%，<0.001），但在随访中显示出更高的转移率（31.0%对10.4%，<0.001）和更高的癌症特异性死亡率（16.7%对6.6%，=0.01）。UE虽然与更高的局部复发相关，但对无转移生存期（MFS）或总生存期（OS）没有显著影响。
PE实现了更好的即时手术结果，但由于肿瘤分期较晚，与更高的转移率和癌症特异性死亡率相关。UE虽然与更高的局部复发率相关，但对MFS或OS没有显著影响。早期检测、全面诊断以及及时转诊至专业肉瘤中心对于避免UE和降低转移风险至关重要。未来的研究应专注于利用个体肿瘤和患者特征开发诊断工具，以改善肉瘤的管理。
