Wang Y, Shen Z, Zhang R
Cancer Hospital, Shanghai Medical University.
Zhonghua Wai Ke Za Zhi. 1996 Jan;34(1):29-32.
The treatment and prognosis of 121 patients with primary and locally recurrent soft tissue sarcomas of the extremities and trunk were analyzed. The most common histologic type was malignant fibrous histocytoma (32 patients, 26.4%). Ninety-three patients had high grade sarcomas (76.9%) and 28 had low grade sarcomas (23.1%). Adjuvant radiotherapy and chemotherapy were applied to 37 and 41 patients respectively. In 28 patients who had local recurrence after surgery, the 5-year local control rate was 72.3%. The overall 5-year survival rate was 59.9% for all patients, and 59.1% for 96 patients with locally recurrent lesions. The independent risk factors affecting the overall survival included high grade, tumor of upper extremity, perioperative blood transfusion, and tumor size of > or = 10 cm. We conclude that (1) wide excision is the most accepted operative procedure for treatment of soft tissue sarcoma of the extremity and trunk unless the lesions are locally advanced (In the advanced cases amputation should be performed); (2) in patients with local recurrence only, there is an almost same rate of long-term salvage as that in patients with primary tumors; (3) avoiding unnecessary perioperative blood transfusion may improve survival; and (4) further investigation of more effective regimen of adjuvant radiotherapy and chemotherapy needs to be taken.
对121例四肢及躯干原发性和局部复发性软组织肉瘤患者的治疗及预后进行了分析。最常见的组织学类型是恶性纤维组织细胞瘤(32例,26.4%)。93例患者为高级别肉瘤(76.9%),28例为低级别肉瘤(23.1%)。分别对37例和41例患者应用了辅助放疗和化疗。在28例术后局部复发的患者中,5年局部控制率为72.3%。所有患者的5年总生存率为59.9%,96例局部复发病变患者的5年总生存率为59.1%。影响总生存的独立危险因素包括高级别、上肢肿瘤、围手术期输血以及肿瘤大小≥10 cm。我们得出结论:(1)广泛切除是治疗四肢及躯干软组织肉瘤最常用的手术方法,除非病变局部进展(在进展期病例应行截肢术);(2)仅局部复发的患者,其长期挽救率与原发性肿瘤患者几乎相同;(3)避免不必要的围手术期输血可能改善生存;(4)需要进一步研究更有效的辅助放疗和化疗方案。