A Postoperative Nomogram for Local Recurrence Risk in Extremity Soft Tissue Sarcomas After Limb-Sparing Surgery Without Adjuvant Radiation
A Postoperative Nomogram for Local Recurrence Risk in Extremity Soft Tissue Sarcomas After Limb-Sparing Surgery Without Adjuvant Radiation
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DOI：
10.1097/sla.0b013e3182367aa7
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发表时间：
2012-02-01
影响因子：
9
通讯作者：
Alektiar, Kaled M.
中科院分区：
文献类型：
--
作者：
Cahlon, Oren;Brennan, Murray F.;Alektiar, Kaled M.
目的：开发一个诺模图的基础上，临床病理因素，以量化局部复发（LR）的风险保肢手术后，没有辅助radiation（RT）。方法：回顾我们的前瞻性肉瘤数据库确定了684例原发性，非转移性，四肢STS治疗保肢手术单独在1982年6月至2006年12月。无患者接受辅助放疗或化疗。使用Gray检验分析年龄、性别、分级、深度、大小、部位、边缘状态和组织学对局部复发率的预后意义。在单变量分析中在0.05水平上显著的变量被输入多变量竞争风险回归模型。在多变量分析的基础上，使用R库cmprsk和QHScrnomo建立了预测LR 3年和5年风险的诺模图。计算一致性指数（C指数），以评估的判别力的预后model.Results：与中位随访58个月的审查患者（73个月的所有患者），总体3年和5年的精算局部复发率分别为11%和13%，分别。列线图中包括的因素包括年龄（50）、大小（5 cm）、边缘状态（阴性与阳性）、级别（低与高）和组织学（非典型脂肪瘤/高分化脂肪肉瘤与其他）。STS诺模图预测局部复发率的C指数为0.73。结论：包括年龄、大小、切缘状态、肿瘤分级和组织学的肢体STS诺模图可预测无辅助RT的保肢手术后3年和5年局部复发的风险。
Purpose: To develop a nomogram based on clinicopathologic factors to quantify the risk of local recurrence (LR) after limb-sparing surgery without adjuvant radiation (RT).Methods: Review of our prospective sarcoma database identified 684 patients with primary, nonmetastatic, extremity STS treated with limb-sparing surgery alone between June 1982 and December 2006. No patient received adjuvant radiation or chemotherapy. Age, sex, grade, depth, size, site, margin status and histology were analyzed for prognostic significance with respect to local recurrence rates using Gray's test. Variables which were significant in univariate analysis at the 0.05 level were entered into a multivariate competing risk regression model. On the basis of the multivariate analysis, a nomogram for predicting the 3- and 5-year risk of LR was developed using R libraries cmprsk and QHScrnomo. Concordance index (C-index) was calculated to evaluate the discriminatory power of the prognostic model.Results: With a median follow-up of 58 months for censored patients (73months for all patients), the overall 3- and 5-year actuarial local recurrence rates were 11% and 13%, respectively. Factors included in the nomogram were age (50), size (5 cm), margin status (negative vs. positive), grade (low vs. high), and histology (atypical lipomatous tumor/well differentiated liposarcoma vs. other). The STS nomogram predicted the local recurrence rate with a C-index of 0.73.Conclusions: A nomogram for extremity STS that includes age, size, margin status, grade of tumor, and histology predicts the 3- and 5-year risk of local recurrence after limb-sparing surgery in the absence of adjuvant RT.