Sheth D S, Yasko A W, Johnson M E, Ayala A G, Murray J A, Romsdahl M M
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1996 Aug 15;78(4):745-50. doi: 10.1002/(SICI)1097-0142(19960815)78:4<745::AID-CNCR9>3.0.CO;2-D.
Chondrosarcoma (CS) most commonly involves the pelvis. Local and systemic failures often result in poor outcome. Prognostic factors that determine patient outcome remain ill-defined.
We retrospectively analyzed 67 patients with CS of the pelvis treated by definitive surgery from January 1970 to December 1992. All patients had localized disease including Grade 1 (19 patients), Grade 2 (18 patients), Grade 3 (17 patients), and dedifferentiated (13 patients) tumors. Thirty-two patients underwent a limb-sparing surgical resection and 35 patients underwent hemipelvectomy. Follow-up was available for all patients. The median duration of follow-up for the survivors was 115 months (range, 24-288 months).
At last follow-up, 52% of the patients were disease free, 8% were alive with disease, 36% died of disease, and 4% died of other causes. Nineteen patients (28%) had developed a local recurrence (LR). The median time to LR was 23 months (range, 1-111 months). Independent variables in a multivariate analysis associated with increased risk of LR included inadequate surgical margin, tumor epicenter in the pubis, and high grade histology. LR did not influence overall patient survival. Twenty-three patients (36%) developed distant metastases at a median time of 9 months (range, 1-111 months) postoperatively. Metastases developed in 0% of the patients with Grade 1, 20% of the patients with Grade 2 60% of the patients with Grade 3 and 75% of patients with dedifferentiated CS. On multivariate analysis, histologic high grade was the only significant predictive variable for distant relapse (P = 0.005).
The critical issue for a favorable outcome in low grade CS of the pelvis is adequate surgical excision (i.e., negative surgical margin). The high rate of systemic failure in high grade and dedifferentiated CS, despite adequate surgery, emphasizes the need for more effective systemic therapy.
软骨肉瘤（CS）最常累及骨盆。局部和全身复发常导致预后不良。决定患者预后的预后因素仍不明确。
我们回顾性分析了1970年1月至1992年12月期间接受确定性手术治疗的67例骨盆CS患者。所有患者均为局限性疾病，包括1级（19例）、2级（18例）、3级（17例）和去分化（13例）肿瘤。32例患者接受了保肢手术切除，35例患者接受了半骨盆切除术。所有患者均有随访。幸存者的中位随访时间为115个月（范围24 - 288个月）。
在最后一次随访时，52%的患者无疾病，8%的患者带瘤生存，36%的患者死于疾病，4%的患者死于其他原因。19例患者（28%）出现局部复发（LR）。LR的中位时间为23个月（范围1 - 111个月）。多变量分析中与LR风险增加相关的独立变量包括手术切缘不足、肿瘤位于耻骨的中心以及高分级组织学。LR不影响患者总体生存。23例患者（36%）在术后中位时间9个月（范围1 - 111个月）出现远处转移。1级患者中0%发生转移，2级患者中20%发生转移，3级患者中60%发生转移，去分化CS患者中75%发生转移。多变量分析中，组织学高分级是远处复发的唯一显著预测变量（P = 0.005）。
骨盆低级别CS获得良好预后的关键问题是充分的手术切除（即手术切缘阴性）。尽管手术充分，但高级别和去分化CS的全身复发率高，这强调了需要更有效的全身治疗。
