Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities
Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities
复制标题
DOI：
10.1200/jco.1996.14.5.1679
复制
发表时间：
1996-05-01
影响因子：
45.3
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Pisters, PWT;Leung, DHY;Brennan, MF
目的：在一组连续治疗的四肢软组织肉瘤患者中，确定无事件生存的特定独立不良临床病理因素。前瞻性地收集了1,041例成人患者的数据，（美国癌症联合委员会[AJCC] IA至IIIB期）四肢软组织肉瘤进行分析，1982年至1994年期间，患者在一家机构接受治疗。患者，肿瘤和病理因素进行了分析，通过单变量和多变量技术，以确定独立的预后因素为终点的局部复发，远处复发，疾病特异性生存，和转移后survival.Results：5年生存率为这一队列的患者为76%，中位随访时间为3.95年。局部复发的重要独立不良预后因素是年龄大于50岁，复发性疾病，显微镜下手术切缘阳性，组织学亚型纤维肉瘤和恶性周围神经肿瘤。对于远处复发，中等肿瘤大小，大肿瘤大小，高组织学分级，深位置，在介绍，平滑肌肉瘤和非脂肪肉瘤组织学复发疾病是独立的不良预后因素。对于疾病特异性生存率，肿瘤体积大，级别高，位置深，疾病复发，组织学亚型平滑肌肉瘤和恶性周围神经肿瘤，显微镜下手术切缘阳性，下肢部位是不利因素。对于转移后生存，只有大的肿瘤大小（> 10厘米）是一个不利的预后因素。结论：独立的不利预后因素，远处复发和疾病特异性生存不同于那些确定为随后的局部复发。显微镜下手术切缘阳性的患者或局部复发性疾病的患者随后局部复发和肿瘤相关死亡的风险增加。特定的组织病理学亚型与局部失败和肿瘤相关死亡率的风险增加相关。(C)1996年，美国临床肿瘤学会。
Purpose: To identify specific independent adverse clinicopathologic factors for event-free survival in a cohort of consecutively treated patients with extremity soft tissue sarcomas.Patients and Methods: prospectively collected data from a population of 1,041 adult patients with localized (American Joint Committee on Cancer [AJCC] stage IA to IIIB) extremity soft tissue sarcomas were analyzed, patients were treated at a single institution between 1982 and 1994. Patient, tumor, and pathologic factors were analyzed by univariate and multivariate techniques to identify independent prognostic factors for the end points of local recurrence, distant recurrence, disease-specific survival, and postmetastasis survival.Results: The 5-year survival rate for this cohort of patients was 76%, with a median follow-up time of 3.95 years. Significant independent adverse prognostic factors for local recurrence were age greater than 50 years, recurrent disease at presentation, microscopically positive surgical margins, and the histologic subtypes fibrosarcoma and malignant peripheral-nerve tumor. For distant recurrence, intermediate tumor size, large tumor size, high histologic grade, deep location, recurrent disease at presentation, leiomyosarcoma, and nonliposarcoma histology were independent adverse prognostic factors. For disease-specific survival, large tumor size, high grade, deep location, recurrent disease at presentation, the histologic: subtypes leiomyosarcoma and malignant peripheral-nerve tumor, microscopically positive surgical margins, and lower extremity site were adverse factors. For postmetastasis survival, only large tumor size (> 10 cm) was an adverse prognostic factor.Conclusion: The independent adverse prognostic factors for distant recurrence and disease-specific survival differ from those identified for subsequent local recurrence. Patients with microscopically positive surgical margins or patients who present with locally recurrent disease are at increased risk for subsequent local recurrence and tumor-related mortality. Specific histopathologic subtypes are associated with increased risks for local failure and tumor-related mortality. (C) 1996 by American Society of Clinical Oncology.