ADULT SOFT-TISSUE SARCOMAS - A PATTERN OF CARE SURVEY OF THE AMERICAN-COLLEGE-OF-SURGEONS
ADULT SOFT-TISSUE SARCOMAS - A PATTERN OF CARE SURVEY OF THE AMERICAN-COLLEGE-OF-SURGEONS
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DOI：
10.1097/00000658-198704000-00003
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发表时间：
1987-04-01
影响因子：
9
通讯作者：
WINCHESTER, D
中科院分区：
文献类型：
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作者：
LAWRENCE, W;DONEGAN, WL;WINCHESTER, D
在美国外科医师学会癌症委员会的主持下，开展了一项关于成人软组织肉瘤的临床表现、病理和治疗的全国性调查。两个独立的两年期被用来评估护理模式的变化。数据来自1977-1978年的504家医院(2355名患者)和1983-1984年的645家机构(3457名患者)。令人感兴趣的治疗前发现包括一些证据表明，诊断的物理延迟，过度使用切除活检而不是通常首选的切开活检方法，美国癌症分期联合委员会(AJCS)系统的使用率较低，以及主要依赖CT进行治疗前患者评估。在大约四分之三的患者中，手术是主要的治疗方法，不管有没有辅助治疗。另外四分之一的患者主要是确诊时有远处转移的患者。多模式治疗在第二阶段确实出现了一些增加，但在两个研究阶段截肢率都很低(约10%)。生存曲线支持AJCCS系统的预后有效性和软组织肉瘤完全切除的价值。不良预后因素包括手术切缘阳性、肿瘤较大、腹膜后或纵隔原发部位、某些组织学类型以及是否需要辅助治疗。由于选择患者接受这些治疗的标准，接受辅助放疗或化疗的患者的生存数据不如仅接受手术治疗的患者。在1977-1978年的系列治疗失败中，大约有一半是局部区域的，而18%仅限于肺转移。抢救治疗对这两种治疗失败的患者，5年生存率分别为61%和21%。
A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 patients) and 645 institutions in 1983-1984 (3457 patients). Pretreatment findings of interest included some evidence of physican delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.