Willers H, Hug E B, Spiro I J, Efird J T, Rosenberg A E, Wang C C
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114-2617, USA.
Int J Radiat Oncol Biol Phys. 1995 Oct 15;33(3):585-93. doi: 10.1016/0360-3016(95)00256-X.
To analyze our experience treating soft tissue sarcomas of the head and neck in adults, and to identify patterns of failure and prognostic factors.
The records of 57 patients with Stage M0 disease treated by radiation with or without surgery between 1972 and 1993 were reviewed. Median follow-up time was 4.3 years (range, 1.1-16.8 years). A group of potential prognostic factors was evaluated, including age at diagnosis, sex, initial tumor presentation (primary vs. recurrent), grade, T-stage, direct tumor extension, tumor depth, duration of treatment, and radiation dose.
The subset of angiosarcomas (11 out of 57 patients) had a considerably adverse effect on treatment outcome for the total group of sarcomas, with actuarial 5-year overall survival (OS), locoregional control (LRC), and freedom from distant metastasis (FDM) rates being 31%, 24%, and 42%, respectively. In contrast, for the remaining 46 patients with other histopathological tumor types, OS, LRC, and FDM rates were significantly higher (74%, 69%, and 83%, respectively). For this group of patients, significant prognostic factors identified by uni- and multivariate analysis included tumor grade as a predictor of OS and T-stage as a predictor of LRC (p < or = 0.050). Those patients who experienced a locoregional recurrence were at a significantly increased risk of dying (p = 0.004 in a multivariate model). All 17 patients without direct tumor extension to neurovascular structures, bone, contiguous organs, or skin remained free from distant failure. In contrast, 27% of 29 patients with direct extension had developed distant metastases at 5 years. In multivariate analysis, the absence of direct extension was a positive predictor of FDM (p = 0.007) and of OS (p = 0.034).
分析我们治疗成人头颈部软组织肉瘤的经验，并确定失败模式和预后因素。
回顾了1972年至1993年间57例M0期疾病患者接受放疗或放疗联合手术治疗的记录。中位随访时间为4.3年（范围1.1 - 16.8年）。评估了一组潜在的预后因素，包括诊断时的年龄、性别、初始肿瘤表现（原发 vs 复发）、分级、T分期、肿瘤直接扩展、肿瘤深度、治疗持续时间和放疗剂量。
血管肉瘤亚组（57例患者中的11例）对肉瘤总组的治疗结果有相当大的不利影响，5年精算总生存率（OS）、局部区域控制率（LRC）和无远处转移率（FDM）分别为31%、24%和42%。相比之下，其余46例其他组织病理学肿瘤类型的患者，OS、LRC和FDM率显著更高（分别为74%、69%和83%）。对于该组患者，单因素和多因素分析确定的显著预后因素包括作为OS预测指标的肿瘤分级和作为LRC预测指标的T分期（p≤0.050）。那些经历局部区域复发的患者死亡风险显著增加（多因素模型中p = 0.004）。所有17例肿瘤未直接扩展至神经血管结构、骨骼、相邻器官或皮肤的患者均无远处失败。相比之下，29例有直接扩展的患者中有27%在5年时发生了远处转移。在多因素分析中，无直接扩展是FDM（p = 0.007）和OS（p = 0.034）的阳性预测指标。
1）头颈部血管肉瘤的预后比该部位的其他软组织肉瘤差得多。2）除肿瘤分级和大小外，肿瘤直接扩展可能是一个有用的额外分期参数。3）头颈部区域局部区域失败率高，这是发病和死亡的潜在原因，表明需要改进治疗策略。
