Li X Q, Parkekh S G, Rosenberg A E, Mankin H J
Orthopaedic Oncology Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Ann Surg Oncol. 1996 Nov;3(6):550-7. doi: 10.1007/BF02306088.
Although improved staging technology, limb-sparing surgery, and adjunctive radiation and chemotherapy have improved the outlook for patients with malignant soft-tissue tumors of the trunk and extremities, it is evident that we cannot predict which patients will develop distant metastases. Although local control is now frequently achieved, most series of high-grade soft-tissue sarcomas carry a mortality rate of > 50%.
In a retrospective study of 93 patients with high-grade sarcomas treated between 1986 and 1992 for whom complete studies including size and volume measurements and DNA ploidy determinations as assessed by flow cytometry were available, a search for a marker for increased risk of metastasis or death was performed.
Grade of the lesion, sex, diagnosis, anatomical site, ploidic data (including mean DNA index and presence of an aneuploid peak), and treatment factors (including type of surgery, local recurrence, or radiation protocol) did not correlate with outcome. Age (younger patients did better), size (greatest diameter) and volume, and positive margins at surgery correlated with total survival.
The results of the study, although negative, point out that using anatomical site, diagnosis, or ploidic analysis offers little toward anticipating outcome, whereas the size of the tumor is important.
尽管分期技术的改进、保肢手术以及辅助放疗和化疗改善了躯干和四肢恶性软组织肿瘤患者的预后，但显然我们无法预测哪些患者会发生远处转移。虽然目前局部控制常常能够实现，但大多数高级别软组织肉瘤系列研究的死亡率都超过50%。
对1986年至1992年间接受治疗的93例高级别肉瘤患者进行回顾性研究，这些患者有完整的研究资料，包括通过流式细胞术评估的大小和体积测量以及DNA倍体测定，旨在寻找转移或死亡风险增加的标志物。
病变分级、性别、诊断、解剖部位、倍体数据（包括平均DNA指数和非整倍体峰的存在）以及治疗因素（包括手术类型、局部复发或放疗方案）与预后均无相关性。年龄（年轻患者预后较好）、大小（最大直径）和体积，以及手术切缘阳性与总生存期相关。
该研究结果虽然为阴性，但指出利用解剖部位、诊断或倍体分析对预测预后帮助不大，而肿瘤大小很重要。
