Clinicopathologic re-evaluation of 100 malignant fibrous histiocytomas:: Prognostic relevance of subclassification
Clinicopathologic re-evaluation of 100 malignant fibrous histiocytomas:: Prognostic relevance of subclassification
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DOI：
10.1200/jco.2001.19.12.3045
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发表时间：
2001-06-15
影响因子：
45.3
通讯作者：
Åkerman, M
中科院分区：
文献类型：
--
作者：
Fletcher, CDM;Gustafson, P;Åkerman, M
目的：恶性纤维组织细胞瘤(MFH)是成人最常见的软组织肉瘤。然而，其真实性质和这一诊断性概念的有效性越来越受到质疑。现有的Delta表明，大多数MFH患者可以细分为特定的STS类型，但这种分类的临床相关性一直存在争议。在一项回顾研究中，我们对100例主要诊断为MFH的四肢和躯干壁肿瘤进行了重新分类，并对结果进行了分析。患者和方法：患者为成年人(中位年龄70岁；范围32至94岁)。肿瘤大小中位数为8 cm(1~30 cm)，最常见的部位为大腿(n=31)。中位随访期为8年(3~16年)。总的5年无转移生存率为0.64。对肿瘤进行组织学、免疫组织化学和超微结构的重新分析，并根据严格的诊断标准进行分类。根据美国癌症系统联合委员会对患者进行分期，并比较重新分类诊断的不同组之间的预后，特别是肌源性肿瘤。结果：在100个肿瘤中，有84个被证实或强烈建议了一条特定的分化路线。最常见的诊断是粘液纤维肉瘤(n=22)和平滑肌肉瘤(n=20)，总共有30个肿瘤可以归类为某种形式的肌源性肉瘤。即使在相同的美国癌症联合委员会内，这些肿瘤的预后也更差，转移时间也比非肌源性肿瘤短。结论：这项回顾性研究证实，大多数所谓的MFH可以根据定义的标准进行细分；这为这种分类具有临床重要性提供了证据。具体地说，显示肌源性分化的多形性ST明显更具侵略性，这一发现允许计划未来的治疗试验。J Clin Oncol19：3045-3050。(C)2001年，由美国临床肿瘤学会主办。
Purpose: Malignant fibrous histiocytoma (MFH) has been regarded as the most common soft tissue sarcoma (STS) in adults. Yet its true nature and the validity of this diagnostic concept have increasingly been questioned. Available delta suggest that most patients with MFH can be subclassified into specific STS types, but the clinical relevance of such categorization has been argued, In a retrospective study, we reclassified 100 tumors of the extremity and trunk wall primarily diagnosed as MFH and analyzed the outcome.Patients and Methods: Patients were adults (median age, 70 years; range, 32 to 94 years). The median tumor size was 8 cm (range, 1 to 30 cm), and the thigh was the most common tumor location (n = 31). Median follow-up was 8 years (range, 3 to 16 years). The overall 5-year metastasis-free survival rate was 0.64. The tumors were reanalyzed histologically, immunohistochemically, and, where available, ultrastructurally, and were classified according to strict diagnostic criteria. Patients were staged according to the American Joint Committee on Cancer system, and prognoses were compared among different groups of the reclassified diagnoses, paying special attention to myogenic tumors.Results: In 84 of 100 tumors, a specific line of differentiation was either proved or strongly suggested. The most common diagnoses were myxofibrosarcoma (n = 22) and leiomyosarcoma (n = 20), Overall, 30 tumors could be grouped as some form of myogenic sarcoma. These tumors had a worse prognosis, even within the same American Joint Committee on Cancer stage, and a shorter time to metastasis than nonmyogenic tumors.Conclusion: this retrospective study confirms that most so-called MFH can be subclassified by defined criteria; it provides evidence that such classification is clinically important. Specifically, pleomorphic STS showing myogenic differentiation are significantly more aggressive, a finding that allows planning future therapeutic trials. J Clin Oncol 19:3045-3050. (C) 2001 by American Society of Clinical Oncology.