Prognostic factors in adult patients with locally controlled soft tissue sarcoma: A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group
Prognostic factors in adult patients with locally controlled soft tissue sarcoma: A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group
复制标题
DOI：
10.1200/jco.1996.14.3.869
复制
发表时间：
1996-03-01
影响因子：
45.3
通讯作者：
Contesso, G
中科院分区：
文献类型：
--
作者：
Coindre, JM;Terrier, P;Contesso, G
目的：确定局部控制性软组织肉瘤（STS）成人患者的预后因素，并确定哪些患者应考虑辅助治疗。患者和方法：研究了546例非转移性和局部控制的STS患者，这些患者来自法国癌症中心联合会（FNCLCC）肉瘤组1980年至1989年的合作数据库。所有患者的组织学切片都被共同审查。最初的治疗包括完全切除肿瘤并截肢，只有4%的患者。辅助放疗占57.9%，辅助化疗占31%。分析肿瘤特征之间的关系，并使用Cox模型对肿瘤死亡率、远处转移的危险率和严格的局部复发进行单因素和多因素分析。结果：对肿瘤死亡率有独立预后价值的不利特征为：3级（P = 3 × 10(-10)）、男性（P = 1.5 × 10(-5)）、未进行辅助化疗（P = 5.4 × 10(-5)）、肿瘤大小大于或等于5cm （P = 3.8 × 10(-3)）、肿瘤深部（P = 4.6 × 10(-3)）。发生远处转移的不利特征为：3级（P = 4 × 10(-12)）、未进行辅助化疗（P = 6.4 × 10(-4)）、肿瘤大小大于或等于10 cm （P = 9.8 × 10(-4)）、深部（P = 1.3 × 10(-3)）。对于局部复发的发展，不利的特点是：没有辅助放疗（P = 3.6 × 10(-6)），手术不良（局部切除）（P = 2 × 10(-4)）， 3级（P = 7.6 × 10(-4)），深部（P = 10(-2)）。根据转移风险，分级、深度和肿瘤大小来定义患者组。仅在3级肿瘤患者的总生存期和无转移生存期方面，辅助化疗是有益的。尽管辅助放疗患者在肿瘤深度、肿瘤淋巴结转移（TNM）和美国联合委员会(AJC)/国际抗癌联盟（UICC）分类和分级方面的特征更差，但后者的局部复发率明显低于未放疗患者。结论：肿瘤分级、肿瘤深度和肿瘤大小可作为选择高转移风险患者的依据，对这些患者进行辅助化疗是有益的。(C)美国临床肿瘤学会1996。
Purpose: To define the prognostic factors in adult patients with locally controlled soft tissue sarcoma (STS) and to determine which patients should be considered for adjuvant treatment.Patients and Methods: Five hundred forty-six patients with a nonmetastatic and locally controlled STS, collected in a cooperative data base by the French Federation of Cancer Centers (FNCLCC) Sarcoma Group from 1980 and 1989, were studied. Histologic slides of all patients were collegially reviewed. Initial treatment consisted of complete tumor resection with amputation in only 4% of the patients. Adjuvant radiotherapy was administered to 57.9% and adjuvant chemotherapy to 31%. Relationships between tumor characteristics were analyzed, and univariate and multivariate analyses were performed using Cox models for the hazards rate of tumor mortality, development of distant metastasis, and strictly local recurrence.Results: Unfavorable characteristics with an independent prognostic value for tumor mortality were: grade 3 (P = 3 x 10(-10)), male sex (P = 1.5 x 10(-5)), no adjuvant chemotherapy (P = 5.4 x 10(-5)), tumor size greater than or equal to 5 cm (P = 3.8 x 10(-3)), and deep location(P = 4.6 x 10(-3)). Unfavorable characteristics for the development of distant metastasis were: grade 3 (P = 4 x 10(-12)), no adjuvant chemotherapy (P = 6.4 x 10(-4)), tumor size greater than or equal to 10 cm (P = 9.8 x 10(-4)), and deep location (P = 1.3 x 10(-3)). For the development of local recurrence, the unfavorable characteristics were: no adjuvant radiotherapy (P = 3.6 x 10(-6)), poor surgery (local excision) (P = 2 x 10(-4)), grade 3 (P = 7.6 x 10(-4)), and deep location (P = 10(-2)). Grade, depth, and tumor size were used to define groups of patients according to the metastatic risk. Adjuvant chemotherapy was beneficial in terms of overall survival and metastasis-free survival in grade 3 tumor patients only. Despite worse characteristics concerning tumor depth, tumor-node-metastasis (TNM) and American Joint Committee (AJC)/lnternational Union Against Cancer (UICC) classifications and grade in patients with adjuvant radiotherapy, the latter experienced significantly fewer local recurrences than patients with no radiotherapy.Conclusion: Grade, tumor depth, and tumor size could be used to select patients with a high metastatic risk, for which adjuvant chemotherapy could be beneficial. (C) 1996 by American Society of Clinical Oncology.