软组织肉瘤R0切除患者的术后放疗：欧洲肉瘤CONTICABASE分析结果
Postoperative radiotherapy in patients with R0 resection of soft tissue sarcoma: results from the European sarcoma CONTICABASE analysis.
作者信息
Sunyach Marie-Pierre, Lusque Amélie, Le Péchoux Cécile, Levy Antonin, Sargos Paul, Helfre Sylvie, Thariat Juliette, Moureau Zabotto Laurence, Lerouge Delphine, Llacer Carmen, Mervoyer Augustin, Vogin Guillaume, Chevreau Christine, Ducimetière Françoise, Blay Jean-Yves, Delannes Martine, Ducassou Anne
机构信息
Department of Radiotherapy, Léon Bérard Cancer Center, Lyon 69673, France.
Department of Biostatistics, University Institute of Cancer Toulouse-Oncopôle, Toulouse 311 00, France.
出版信息
Br J Radiol. 2025 Sep 1;98(1173):1409-1418. doi: 10.1093/bjr/tqaf068.
OBJECTIVES
We aim to report the outcomes of soft tissue sarcoma (STS) patients with surgical R0 margin size (large: ≥5 mm or close: ≥1 to <5 mm) tumour, treated or not with postoperative radiotherapy (RT).
METHODS
The Connective Tissue Cancer Network database CONTICABASE collected data from adult patients diagnosed from 1999 to 2016 for histologically-proven locally advanced STS of trunk or limbs, with surgical R0 margin size (large: ≥5 mm; close: ≥1 to <5 mm), who did not receive neoadjuvant/adjuvant chemotherapy. A propensity score matching analysis was performed to account for potential treatment selection biases. We reported local control (LC), disease-free survival (DFS), overall survival (OS), RT impact in subgroup analyses, and performed multivariable analyses adjusted for classical prognostic factors.
RESULTS
Among 738 patients with STS eligible from 11 sites, 524 patients had R0 surgical margins, either treated with postoperative RT (N = 374, 71.4%), or not (N = 150). Besides similar characteristics regarding sex, age, margin size, and preoperative MRI assessment, more tumour localizations in lower limbs (62.8% vs 46%), larger tumours (≥5 cm) (68.4% vs 46%), deeper tumours (75.9% vs 56%), and more grade ≥3 tumours (50.4% vs 32.7%) were reported in patients having received adjuvant RT. The median follow-up was 74.7 [95% CI 71.8-83.0] months, 10-year-LC, -DFS, and -OS were 77.5% [95% CI 71.2-82.6], 51.0% [45.1-56.7], and 69.6% [63.7-74.6], respectively. The multivariable analysis showed that patients with older age and larger tumours are more at risk in terms of LC, DFS, and OS. Preoperative MRI assessment (HR 0.43, 95% CI 0.22-0.83; P = .012) and RT (HR 0.27, 95% CI 0.15-0.49; P < .001) were significantly associated with better LC. However, RT did not impact OS. Subgroup analyses showed that RT also benefit to grade 1 and 2 tumours.
CONCLUSION
This series shows that adjuvant RT improved LC in all patients with STS with surgical R0 resection.
ADVANCES IN KNOWLEDGE
This series did not identify subgroups in whom RT can be deleted.
目的
我们旨在报告手术切缘R0（大切缘：≥5毫米或近切缘：≥1至<5毫米）的软组织肉瘤（STS）患者接受或未接受术后放疗（RT）的治疗结果。
方法
结缔组织癌症网络数据库CONTICABASE收集了1999年至2016年确诊的成年患者的数据，这些患者经组织学证实为躯干或四肢局部晚期STS，手术切缘R0（大切缘：≥5毫米；近切缘：≥1至<5毫米），且未接受新辅助/辅助化疗。进行倾向评分匹配分析以考虑潜在的治疗选择偏倚。我们报告了局部控制（LC）、无病生存期（DFS）、总生存期（OS）、亚组分析中放疗的影响，并对经典预后因素进行了多变量分析。
结果
在来自11个地点的738例符合条件的STS患者中，524例患者有R0手术切缘，其中374例（71.4%）接受了术后放疗，150例未接受。除了在性别、年龄、切缘大小和术前MRI评估方面具有相似特征外，接受辅助放疗的患者下肢肿瘤定位更多（62.8%对46%）、肿瘤更大（≥5厘米）（68.4%对46%）、肿瘤更深（75.9%对56%）以及≥3级肿瘤更多（50.4%对32.7%）。中位随访时间为74.7 [95% CI 71.8 - 83.0]个月，10年LC、DFS和OS分别为77.5% [95% CI 71.2 - 82.6]、51.0% [45.1 - 56.7]和69.6% [63.7 - 74.6]。多变量分析表明，年龄较大和肿瘤较大的患者在LC、DFS和OS方面风险更高。术前MRI评估（HR 0.43，95% CI 0.22 - 0.83；P = 0.012）和放疗（HR 0.27，95% CI 0.15 - 0.49；P < 0.001）与更好的LC显著相关。然而，放疗对OS没有影响。亚组分析表明，放疗对1级和2级肿瘤也有益。
结论
本系列研究表明，辅助放疗可改善所有接受手术R0切除的STS患者的LC。
知识进展
本系列研究未确定可省略放疗的亚组。
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