Do Radiation-Associated Soft Tissue Sarcomas Have the Same Prognosis As Sporadic Soft Tissue Sarcomas?
Do Radiation-Associated Soft Tissue Sarcomas Have the Same Prognosis As Sporadic Soft Tissue Sarcomas?
复制标题
DOI：
10.1200/jco.2009.25.1728
复制
发表时间：
2010-04-20
影响因子：
45.3
通讯作者：
Singer, Samuel
中科院分区：
文献类型：
--
作者：
Gladdy, Rebecca A.;Qin, Li-Xuan;Singer, Samuel
PurposeTo确定放射相关性软组织肉瘤（RAS）的组织学类型的预后意义，并确定RAS是否与散发性软组织肉瘤（STS）相比预后较差。患者和方法从1982年至2007年的7,649例STS患者中确定了130例原发性RAS。对RAS进行了疾病特异性生存（DSS）的临床病理因素的多变量分析，并对RAS和散发性肉瘤进行了放射暴露的多变量分析。一个匹配的队列分析进行放射相关的和散发性恶性纤维组织细胞瘤（MFH）。结果大多数RAS高级别（83%），深（87%），和躯干（61.5%）。放射治疗和RAS发生之间的中位间隔为10年（范围1.3 - 74年），不同组织学类型差异显著（P = .003）。5年DSS为58%，独立预测因素为肿瘤大小> 5 cm、切缘阳性和组织学类型。原发性、高级别放射相关性和散发性STS的组织学类型的多变量分析显示，RAS与更差的DSS相关（风险比，1.7;范围，1.1至2.4; P = 0.007）。对于多形性MFH-最常见的RAS类型，5年DSS为44%，而在散发性MFH患者的匹配队列中为66%（P = 0.07）。DSS是显着恶化原发性RAS恶性外周神经鞘膜瘤（MPNSTs）相比，不匹配的散发MPNSTs（P = .001）。结论组织学类型，边缘状态和肿瘤大小是最重要的独立预测因子DSS患者RAS。原发性RAS患者的DSS明显比散发性STS差，与肉瘤的组织学类型无关。J Clin Oncol 28：2064-2069. (C)2010年美国临床肿瘤学会
PurposeTo determine the prognostic significance of histologic type in radiation-associated soft tissue sarcomas (RASs) and determine whether RASs are associated with an inferior prognosis compared with sporadic soft tissue sarcomas (STSs).Patients and MethodsOne hundred thirty primary RASs were identified from 7,649 STS patients from 1982 to 2007. Multivariate analysis of clinicopathologic factors for disease-specific survival (DSS) was performed for RASs, and a multivariate analysis of radiation exposure was also performed for RASs and sporadic sarcomas. A matched-cohort analysis was performed for radiation-associated and sporadic malignant fibrous histiocytoma (MFH).ResultsMost RASs were high grade (83%), deep (87%), and truncal (61.5%). The median interval between radiation therapy and RAS development was 10 years (range, 1.3 to 74 years), which varied significantly by histologic type (P = .003). The 5-year DSS was 58%, and independent predictors were size > 5 cm, margin positivity, and histologic type. Multivariate analysis of histologic types of primary, high-grade radiation-associated and sporadic STSs showed that RAS was associated with a worse DSS (hazard ratio, 1.7; range, 1.1 to 2.4; P = .007). For pleomorphic MFH-the most common RAS type-the 5-year DSS was 44% versus 66% in a matched cohort of sporadic MFH patients (P = .07). DSS was significantly worse in primary RAS malignant peripheral nerve sheath tumors (MPNSTs) compared with unmatched sporadic MPNSTs (P = .001).ConclusionHistologic type, margin status, and tumor size are the most important independent predictors of DSS in patients with RASs. DSS in patients with primary RAS is significantly worse compared with sporadic STS independent of sarcoma histologic type. J Clin Oncol 28: 2064-2069. (C) 2010 by American Society of Clinical Oncology