Undifferentiated Pleomorphic Sarcoma: Long-Term Follow-Up from a Large Institution
Undifferentiated Pleomorphic Sarcoma: Long-Term Follow-Up from a Large Institution
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DOI：
10.2147/cmar.s226896
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发表时间：
2019-01-01
影响因子：
3.3
通讯作者：
Wang, Chunmeng
中科院分区：
文献类型：
--
作者：
Chen, Shiqi;Huang, Wending;Wang, Chunmeng
目的：描述未分化多形性肉瘤(UPS)的临床特征，并找出预后不良的预测因素。患者和方法：回顾2004年11月至2016年7月在同一机构接受手术切除的100例UPS患者的临床病理变量和治疗策略。生存分析采用Kaplan-Meier和Cox回归方法。结果：中位随访时间为94个月(1.5~154个月)。72例行R0切除，肿瘤平均大小为5.75 cm(1~30 cm)。45例肿瘤分级为中度(G2)，54例为晚期(III/DO期)。肿瘤累及重要结构27例，其中神经受累最多(n=12)。术后局部复发40例，远处转移25例，以肺转移为主(n=14)。5年OS率为53%，5年LRFS率为55%，5年MFS率为70%。多因素分析显示，肿瘤表现、肿瘤大小和受累的重要结构(分别为p=0.033、p=0.004和p=0.033)是与OS相关的独立预后因素。多因素分析显示，年龄、切除质量和肿瘤分级是影响预后的独立因素(p=0.033、p=0.045和p=0.007)，肿瘤深度与无瘤生存率显著相关(p=0.050)。结论：早期治疗应由大型肉瘤中心的专家进行。宽阔的手术切缘可以充分控制疾病的复发。
Purpose: Our study aimed to describe the clinical features of undifferentiated pleomorphic sarcoma (UPS) and identify the predictors of poor outcomes.Patients and methods: The clinicopathological variables and treatment strategies of 100 UPS patients who underwent surgical resections at a single institution between November 2004 and July 2016 were reviewed. Kaplan-Meier and Cox regression method were conducted for survival analysis.Results: The median follow-up time was 94 months (range, 1.5-154 months). R0 resection was applied for 72 cases, and the median tumor size was 5.75cm (range, 1-30cm). Tumor grades of 45 patients were intermediate grade (G2), and 54 patients were with advanced stage (stage III/DO. Twenty-seven patients presented with tumors involving important structures, in which the nerve was the most frequently invaded structure (n=12). During the follow-up, 40 patients suffered from postoperative local recurrence, and distant metastasis was observed in 25 patients which mainly metastasized to the lung (n=14). The 5-year OS rate, 5-year LRFS rate, and 5-year MFS rate was 53%, 55%, and 70%, respectively. Multivariate analysis revealed that tumor presentation, tumor size, and important structures involved (p=0.033, p=0.004, and p=0.033, respectively) were independent prognostic factors associated with OS. Meanwhile, age, resection quality and tumor grade were independent prognostic factors for LRFS (p=0.033, p=0.045, and p=0.007, respectively) and tumor depth was significantly associated with MFS (p=0.050) in multivariate analysis.Conclusion: Primary treatment of UPS should be conducted by experts in large sarcoma center. Wide surgical margin provides sufficient control of the disease recurrence.