Infiltrative MRI pattern and incomplete initial surgery compromise local control of myxofibrosarcoma
Infiltrative MRI pattern and incomplete initial surgery compromise local control of myxofibrosarcoma
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DOI：
10.1097/01.blo.0000229292.98850.14
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发表时间：
2006-09-01
影响因子：
4.2
通讯作者：
Athanasian, Edward A.
中科院分区：
文献类型：
--
作者：
Manoso, Mark W.;Pratt, Jeffrey;Athanasian, Edward A.
黏液纤维肉瘤（MFS）的局部失败率高达79%。我们对1990年至2004年间诊断为黏液纤维肉瘤的所有患者进行了回顾性分析，以评估MRI成像改善是否可以减少局部复发，增加生存率，以及切除术后放疗是否影响预后。21例患者接受MFS治疗，中位随访时间为52个月（范围18-122）。所有患者均接受手术治疗，其中19例接受保肢手术。所有疾病程度高、边缘阳性或术前手术的患者均接受放射治疗。有手术史的患者局部复发率为57%(8 / 14)，而没有手术史的患者局部复发率为14%（1 / 7）。先前的边缘切除和弥漫性筋膜扩散MRI预测局部复发率增加。低级别疾病的5年无病生存率为43% (SE, 22%)，高级别疾病的5年无病生存率为39% （SE, 18%）。磁共振成像观察显示一种独特的沿筋膜平面的弥漫性扩散模式，可能是导致局部高复发率的原因。放疗不能补偿阳性切缘，也不能减少阴性切缘后的复发。
Myxofibrosarcoma (MFS) has a high local failure rate of up to 79%. We conducted a retrospective analysis on all patients with the diagnosis of myxofibrosarcoma seen between 1990 and 2004 to assess whether improved imaging with MRI reduced local recurrence, increased survival, and whether radiotherapy following resection influenced outcome. Twenty-one patients were treated for MFS with a median followup of 52 months (range, 18-122). All patients were surgically treated, with 19 receiving limb-sparing surgery. All patients with high grade disease, positive margins, or a prereferral procedure received radiation therapy. The local recurrence rate was 57% for patients with a prior outside procedure (8 of 14), while patients with no prior surgery had a rate of 14% (1 of 7). Prior marginal excision and diffuse fascial spread on MRI predicted an increased local recurrence rate. The disease-free survival at 5 years was 43% (SE, 22%) for low-grade disease and 39% (SE, 18%) for high-grade disease. Magnetic resonance imaging observations suggest a unique pattern of diffuse spread along fascial planes that could be responsible for the high local recurrence. Radiation did not compensate for positive margins, nor did it reduce recurrence after negative margins.