Lewis J J, Leung D, Heslin M, Woodruff J M, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Clin Oncol. 1997 Feb;15(2):646-52. doi: 10.1200/JCO.1997.15.2.646.
The aim of this study was to analyze local recurrence in a large cohort of prospectively followed patients with primary extremity soft tissue sarcoma. In particular, we analyzed the correlation of local recurrence with subsequent metastasis and disease-specific survival.
Patients who underwent treatment for primary extremity soft tissue sarcoma from July 1982 through July 1995 at Memorial Sloan-Kettering Cancer Center were the subject of this study. Local recurrence, distant metastasis, and disease-specific survival were used as end points of the study. The influence of local recurrence on subsequent distant metastasis and disease-specific survival were examined using the Cox proportional hazards model.
We treated 911 patients, of whom 297 (33%) developed recurrent disease. Local recurrence occurred in 116 patients (13%), metastasis in 167 (18%), and synchronous local recurrence and metastasis in 13 (2%). Of 116 patients who developed local recurrence, 38 subsequently developed metastasis and 34 died of disease. Metastasis after local recurrence was predicted in patients with initial high-grade (P = .005; risk = 3.5) or deep (P = .02; risk = 2.9) tumors. Tumor mortality after local recurrence was predicted in patients with initial high-grade (P = .007; risk = 3.7) or large (> 5 cm; P = .01; risk = 3.2) primary tumors.
These findings suggest that there is a strong association of local recurrence with the development of subsequent metastasis and tumor mortality, and that local recurrence is a poor prognostic factor. It would seem prudent to consider patients who develop local recurrence and have high-grade tumors as being at high risk for systemic disease and therefore eligible for investigational adjuvant systemic therapy.
本研究旨在分析一大群接受前瞻性随访的原发性肢体软组织肉瘤患者的局部复发情况。具体而言，我们分析了局部复发与后续转移及疾病特异性生存的相关性。
本研究的对象为1982年7月至1995年7月在纪念斯隆凯特琳癌症中心接受原发性肢体软组织肉瘤治疗的患者。局部复发、远处转移和疾病特异性生存被用作研究的终点。使用Cox比例风险模型检验局部复发对后续远处转移和疾病特异性生存的影响。
我们治疗了911例患者，其中297例（33%）出现复发性疾病。116例患者（13%）发生局部复发，167例（18%）发生转移，13例（2%）发生局部复发与转移同时出现的情况。在116例发生局部复发的患者中，38例随后发生转移，34例死于该疾病。初始为高级别（P = .005；风险 = 3.5）或深部（P = .02；风险 = 2.9）肿瘤的患者，局部复发后发生转移的情况可被预测。初始为高级别（P = .007；风险 = 3.7）或大（> 5 cm；P = .01；风险 = 3.2）原发性肿瘤的患者，局部复发后的肿瘤死亡率可被预测。
这些发现表明，局部复发与后续转移的发生及肿瘤死亡率之间存在密切关联，且局部复发是一个不良的预后因素。对于发生局部复发且患有高级别肿瘤的患者，似乎谨慎的做法是将其视为存在全身疾病的高风险患者，因此有资格接受试验性辅助全身治疗。
