Kawaguchi N, Matsumoto S
Dept. of Orthopaedic Surgery, Cancer Institute Hospital, Japan.
Gan To Kagaku Ryoho. 1996 Jul;23(8):1093-8.
The prognosis of bone and soft tissue sarcoma is influenced by factors such as pulmonary metastasis, local curability and sensitivity to chemotherapy. In cases with pulmonary lesion, the prognosis has not been favorable, but recently long-term survivors are increasing in number by effective chemotherapy, and the removal of primary and metastatic lesions. As in cases without metastatic lesions, the prognosis of high-grade sarcoma were influenced by local curability and sensitivity to chemotherapy. On the other hand, the prognosis in low grade sarcoma is mainly decided by local curability. To assure local curability the following should be considered. 1) safety surgical margin, 2) preoperative radiation therapy if the safety margin is not predicted, and 3) risk factors in local curability, which are lymph node metastasis, skip metastasis and tumor thrombus. If these risk factors are detected before operation, a more radical procedure should be planned. Moreover, cutaneous angiosarcoma and epithelioid sarcoma, which are occasionally associated with these risk factors, should be operated by ablative procedure even if the risk factors are not detected. 4) In cases with pathological fracture or inadequately operated, surgical intervention to prevent transplantation should be undertaken as soon as possible. Effective chemotherapy could improve the prognosis of high grade sarcoma. Thus, chemotherapy should be used for osteosarcoma, Ewings sarcoma, round cell sarcoma etc. However, non-effective chemotherapy might make the prognosis worse. Therefore, alternative administration of effective chemotherapeutic agents proved by clinical evaluation would be more reasonable than remaining with a certain protocol.
骨肉瘤和软组织肉瘤的预后受肺转移、局部可治愈性及对化疗的敏感性等因素影响。对于有肺部病变的病例，预后一直不佳，但近来通过有效的化疗以及原发灶和转移灶的切除，长期存活者的数量在增加。与无转移病变的病例一样，高级别肉瘤的预后受局部可治愈性和对化疗的敏感性影响。另一方面，低级别肉瘤的预后主要取决于局部可治愈性。为确保局部可治愈性，应考虑以下几点。1）安全手术切缘；2）如果预计切缘不安全，则进行术前放疗；3）局部可治愈性的危险因素，即淋巴结转移、跳跃转移和肿瘤血栓。如果在手术前检测到这些危险因素，应计划更彻底的手术。此外，偶尔与这些危险因素相关的皮肤血管肉瘤和上皮样肉瘤，即使未检测到危险因素，也应采用根治性手术。4）对于发生病理性骨折或手术不充分的病例，应尽快进行手术干预以防止肿瘤播散。有效的化疗可改善高级别肉瘤的预后。因此，化疗应用于骨肉瘤、尤因肉瘤、圆形细胞肉瘤等。然而，无效的化疗可能会使预后更差。因此，采用经临床评估证实有效的化疗药物替代给药比遵循某一固定方案更为合理。
