Raasveld Floris V, Hanna Tareq, Pacheco Fernando J, Gonzalez Marcos R, Johnston Benjamin, Lozano-Calderón Santiago A, Valerio Ian L, Eberlin Kyle R
Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Hand and Arm Center, Department of Orthopedics Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2025 May;32(5):3741-3751. doi: 10.1245/s10434-025-17001-9. Epub 2025 Feb 22.
Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas that pose significant challenges in surgical management. This study aims to examine the anatomic distribution of MPNSTs, analyze survival rates and predictive factors for survival, and investigate the prevalence of neuropathic pain in patients who have undergone MPNST resection.
A retrospective analysis of 119 patients who underwent MPNST resection was conducted. Additionally, a cross-sectional survey was administered and completed by 39 surviving patients to assess neuropathic pain prevalence using the NRS (0-10 scale) and the s-DN4 questionnaire, and quality of life (QoL) using the EQ-5D-5L index (0-1 scale).
MPNSTs most commonly occurred in the lower extremity (42.9%), followed by the upper extremity (21.0%), trunk (19.3%), head and neck (11.8%), and pelvis (5.0%). Female sex (OR: 0.25, 95% CI: 0.10-0.61) and absence of metastases (OR: 0.15, 95% CI: 0.05-0.52) were significantly associated with lower odds of mortality. Among survey respondents, 82.1% reported neuropathic pain following MPNST resection. The patients reported a mean EQ-5D-5L index score of 0.566 (± 0.253) as compared with an EQ-5D-5L of 0.851 (± 0.205) for the US general population.
The high prevalence of neuropathic pain following MPNST resection and its significant impact on QoL highlights the need for improved pain management strategies. Nerve-sparing and/or nerve-reconstructive techniques during or after tumor resection should be considered. Future research should focus on identifying risk factors for neuropathic pain development and evaluating the efficacy of preventive measures to improve long-term pain outcomes for surviving patients with MPNST.
恶性外周神经鞘瘤（MPNSTs）是侵袭性软组织肉瘤，在手术治疗中面临重大挑战。本研究旨在检查MPNSTs的解剖分布，分析生存率及生存预测因素，并调查接受MPNST切除的患者中神经性疼痛的患病率。
对119例行MPNST切除的患者进行回顾性分析。此外，对39名存活患者进行了横断面调查，以使用NRS（0 - 10分制）和s - DN4问卷评估神经性疼痛患病率，并使用EQ - 5D - 5L指数（0 - 1分制）评估生活质量（QoL）。
MPNSTs最常见于下肢（42.9%），其次是上肢（21.0%）、躯干（19.3%）、头颈部（11.8%）和骨盆（5.0%）。女性（比值比：0.25，95%置信区间：0.10 - 0.61）和无转移（比值比：0.15，95%置信区间：0.05 - 0.52）与较低的死亡几率显著相关。在调查对象中，82.1%报告在MPNST切除后出现神经性疼痛。患者报告的EQ - 5D - 5L指数平均得分为0.566（±0.253），而美国普通人群的EQ - 5D - 5L得分为0.851（±0.205）。
MPNST切除后神经性疼痛的高患病率及其对生活质量的重大影响凸显了改进疼痛管理策略的必要性。应考虑在肿瘤切除期间或之后采用保留神经和/或神经重建技术。未来的研究应侧重于确定神经性疼痛发生的危险因素，并评估预防措施的效果，以改善MPNST存活患者的长期疼痛结局。
