Synovial sarcoma: A multivariate analysis of prognostic factors in 112 patients with primary localized tumors of the extremity
Synovial sarcoma: A multivariate analysis of prognostic factors in 112 patients with primary localized tumors of the extremity
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DOI：
10.1200/jco.2000.18.10.2087
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发表时间：
2000-05-01
影响因子：
45.3
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Lewis, JJ;Antonescu, CR;Brennan, MF
目的：滑膜肉瘤是一种高级别肿瘤，预后不良。之前分析预后因素的研究有限，因为纳入了非四肢肿瘤和复发性肿瘤患者的异质队列。本研究的目的是确定四肢原发性滑膜肉瘤的独立预后因素。 患者和方法：1982年7月1日至1996年6月30日期间，112名患者在我院接受手术切除治愈，然后进行前瞻性随访，检查预后价值的临床和病理因素包括年龄、性别、肿瘤部位和位置、深度、大小、手术的显微镜状态边缘、骨或神经血管结构的侵犯以及单相或双相组织学，分析的终点是首次局部复发（之前没有远处复发）的时间、任何远处复发的时间以及疾病相关死亡率的时间。使用Kaplan和Meier的方法对这些终点进行建模，并通过对数秩检验和Cox回归进行分析。结果：这组112名患者的幸存者中位随访时间为72个月，5年局部复发率、远处复发率和死亡率分别为12%、39%和25%。肿瘤大小大于或等于 5 cm（P = 0.001；相对风险 [RR] = 2.7；95% 置信区间 [CI]，1.5 至 5.2）和骨或神经血管侵犯（P = 0.04；RR = 2.3；95% CI，1.0 至 5.3）是远处复发的独立不良预测因素。肿瘤大小大于或等于 5 cm（P = .003；RR = 2.3；95% CI，1.4 至 6.3）和骨或神经血管侵犯（P = .03；RR = 2.7；95% CI，1.0 至 6.5）也是死亡率的独立不良预测因素。 结论：四肢原发性滑膜肉瘤的自然史与肿瘤大小以及对骨和神经血管结构的侵袭。 J 临床肿瘤杂志 18：2087-2094。 (C) 2000 年美国临床肿瘤学会。
Purpose: Synovial sarcoma is a high-grade tumor that is associated with poor prognosis. Previous studies analyzing prognostic factors are limited because of inclusion of heterogeneous cohorts of patients with nonextremity and recurrent tumors. The objective of this study was to determine independent prognostic factors of primary synovial sarcoma localized to the extremity.Patients and Methods: Between July 1, 1982, and June 30, 1996, 112 patients underwent surgical resection for cure at our institution and then were followed-up prospectively, Clinical and pathologic factors examined for prognostic value included age, sex, tumor site and location, depth, size, microscopic status of surgical margins, invasion of bone or neurovascular structures, and monophasic or biphasic histology, The end points analyzed were the time to first local recurrence that was not preceded by a distant recurrence, time to any distant recurrence, and time to disease-related mortality. These end points were modeled using the method of Kaplan and Meier and analyzed by the log-rank test and Cox regression.Results: The median duration of follow-up among survivors in this cohort of 112 patients was 72 months, The 5-year local-recurrence, distant-recurrence, and mortality rates were 12%, 39%, and 25%, respectively. Tumor size greater than or equal to 5 cm (P =.001; relative risk [RR] = 2.7; 95% confidence interval [CI], 1.5 to 5.2) and the presence of bone or neurovascular invasion (P =.04; RR = 2.3; 95% CI, 1.0 to 5.3) were independent adverse predictors ab distant recurrence. Tumor size greater than or equal to 5 cm (P =.003; RR = 2.3; 95% CI, 1.4 to 6.3) and the presence of bone or neurovascular invasion (P =.03; RR = 2.7; 95% CI, 1.0 to 6.5) were also independent adverse predictors of mortality.Conclusion: The natural history of primary synovial sarcoma of the extremity is related to tumor size and invasion of bone and neurovascular structures. J Clin Oncol 18:2087-2094. (C) 2000 by American Society of Clinical Oncology.