Coindre J M, Terrier P, Bui N B, Bonichon F, Collin F, Le Doussal V, Mandard A M, Vilain M O, Jacquemier J, Duplay H, Sastre X, Barlier C, Henry-Amar M, Macé-Lesech J, Contesso G
French Federation of Cancer Centers Sarcoma Group, Paris, France.
J Clin Oncol. 1996 Mar;14(3):869-77. doi: 10.1200/JCO.1996.14.3.869.
To define the prognostic factors in adult patients with locally controlled soft tissue sarcoma (STS) and to determine which patients should be considered for adjuvant treatment.
Five hundred forty-six patients with a nonmetastatic and locally controlled STS, collected in a cooperative data base by the French Federation of Cancer Centers (FNCLCC) Sarcoma Group from 1980 and 1989, were studied. Histologic slides of all patients were collegially reviewed. Initial treatment consisted of complete tumor resection with amputation in only 4% of the patients. Adjuvant radiotherapy was administered to 57.9% and adjuvant chemotherapy to 31%. Relationships between tumor characteristics were analyzed, and univariate and multivariate analyses were performed using Cox models for the hazards rate of tumor mortality, development of distant metastasis, and strictly local recurrence.
Unfavorable characteristics with an independent prognostic value for tumor mortality were: grade 3 (P = 3 x 10(-10)), male sex (P = 1.5 x 10(-5)), no adjuvant chemotherapy (P = 5.4 x 10(-5)), tumor size > or = 5 cm (P = 3.8 x 10(-3)), and deep location (P = 4.6 x 10(-3)). Unfavorable characteristics for the development of distant metastasis were: grade 3 (P = 4 x 10(-12)), no adjuvant chemotherapy (P = 6.4 x 10(-4)), tumor size > or = 10 cm (P = 9.8 x 10(-4)), and deep location (P = 1.3 x 10(-3)). For the development of local recurrence, the unfavorable characteristics were: no adjuvant radiotherapy (P = 3.6 x 10(-6)), poor surgery (local excision) (P = 2 x 10(-4)), grade 3 (P = 7.6 x 10(-4)), and deep location (P = 10(-2)). Grade, depth, and tumor size were used to define groups of patients according to the metastatic risk. Adjuvant chemotherapy was beneficial in terms of overall survival and metastasis-free survival in grade 3 tumor patients only. Despite worse characteristics concerning tumor depth, tumor-node-metastasis (TNM) and American Joint Committee (AJC)/International Union Against Cancer (UICC) classifications and grade in patients with adjuvant radiotherapy, the latter experienced significantly fewer local recurrences than patients with no radiotherapy.
Grade, tumor depth, and tumor size could be used to select patients with a high metastatic risk, for which adjuvant chemotherapy could be beneficial.
确定成人局部控制的软组织肉瘤（STS）患者的预后因素，并确定哪些患者应考虑接受辅助治疗。
研究了1980年至1989年由法国癌症中心联合会（FNCLCC）肉瘤小组收集在一个合作数据库中的546例非转移性且局部控制的STS患者。对所有患者的组织学切片进行共同评估。初始治疗包括仅4%的患者进行截肢的完整肿瘤切除。57.9%的患者接受了辅助放疗，31%的患者接受了辅助化疗。分析肿瘤特征之间的关系，并使用Cox模型对肿瘤死亡率、远处转移发生和严格局部复发的风险率进行单因素和多因素分析。
对肿瘤死亡率具有独立预后价值的不良特征为：3级（P = 3×10⁻¹⁰）、男性（P = 1.5×10⁻⁵）、未接受辅助化疗（P = 5.4×10⁻⁵）、肿瘤大小≥5 cm（P = 3.8×10⁻³）和深部位置（P = 4.6×10⁻³）。远处转移发生的不良特征为：3级（P = 4×10⁻¹²）、未接受辅助化疗（P = 6.4×10⁻⁴）、肿瘤大小≥10 cm（P = 9.8×10⁻⁴）和深部位置（P = 1.3×10⁻³）。对于局部复发的发生，不良特征为：未接受辅助放疗（P = 3.6×10⁻⁶）、手术不佳（局部切除）（P = 2×10⁻⁴）、3级（P = 7.6×10⁻⁴）和深部位置（P = 10⁻²）。根据转移风险，使用分级、深度和肿瘤大小来定义患者组。仅在3级肿瘤患者中，辅助化疗在总生存和无转移生存方面有益。尽管接受辅助放疗的患者在肿瘤深度、肿瘤-淋巴结-转移（TNM）和美国联合委员会（AJC）/国际抗癌联盟（UICC）分类及分级方面特征较差，但后者的局部复发明显少于未接受放疗的患者。
分级、肿瘤深度和肿瘤大小可用于选择具有高转移风险的患者，对于这些患者辅助化疗可能有益。
