Primary chest wall tumors: early and long-term results of surgical treatment
Primary chest wall tumors: early and long-term results of surgical treatment
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DOI：
10.1016/s1010-7940(01)00655-8
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发表时间：
2001-05-01
影响因子：
3.4
通讯作者：
Bellenis, I
中科院分区：
文献类型：
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作者：
Athanassiadi, K;Kalavrouziotis, G;Bellenis, I
目的：对原发胸壁肿瘤(PCWTs/CWTS)进行回顾性研究，探讨其临床、影像、病理特点及手术治疗的近期和远期效果。材料和方法：1986~1996年，我科共收治PCWTs患者41例，其中男性18例，女性23例，年龄15~78岁。结果：23例良性CWT患者(男9例，女14例，平均年龄36岁)：内生性软骨瘤5例，纤维异常增殖症4例，神经鞘瘤3例，骨软骨瘤2例，颗粒细胞瘤2例，纤维瘤2例，脂肪瘤2例，纤维脂肪瘤1例，嗜酸性肉芽肿1例，动脉瘤性骨囊肿1例。18例恶性CWT患者(男9例，女9例，平均年龄59岁)：浆细胞瘤5例，软骨肉瘤2例，骨肉瘤2例，纤维肉瘤2例，硬纤维瘤2例，平滑肌肉瘤1例，恶性纤维组织细胞瘤1例，腱鞘肉瘤1例，血管肉瘤1例，神经鞘肉瘤1例。肋骨受累21例，胸骨受累5例，软组织受累17例。仅用放射学标准不可能区分良性和恶性CWT，而且诊断总是通过组织学来证实的。手术治疗包括广泛切除29例(良性15例，恶性14例)，应用人工网片5例，切除或切开活检12例。无围手术期死亡。2例良性CWT患者(纤维瘤1例，神经鞘瘤1例)分别于术后13个月和26个月局部复发，并行广泛切除(复发率8.7%)。随访3~13年，良性CWT患者中有1例非肿瘤相关死亡(总死亡率4.3%)，无其他局部复发。恶性CWT患者总的5年和10年生存率为33.3%。结论：我们认为所有的CWTs都应该被认为是恶性的，直到证明并非如此。为了在良性和恶性病变中提供最好的治愈机会，需要进行无肿瘤边缘的广泛切除。(C)2001 Elsevier Science B.V.保留所有权利。
Objectives: A retrospective study of primary chest wall tumors (PCWTs/CWTs) was conducted to review their clinical, radiological and pathological features, as well as the early and long-term results of surgical management. Materials and methods: From 1986 through 1996, 41 patients (18/44% male, 23/56% female, aged 15-78 years) with PCWTs were treated in our department. Results: Twenty-three patients (nine male, 14 female, mean age 36 years) had a benign CWT: enchondroma, five patients; fibrous dysplasia, four patients; neurilemoma, three patients; osteochondroma, two patients; granular cell tumor, two patients; fibroma, two patients; lipoma, two patients; fibrolipoma, one patient; eosinophilic granuloma, one patient; aneurysmal bone cyst, one patient. Eighteen patients (nine male, nine female, mean age 59 years) had a malignant CWT: plasmacytoma, five patients; chondrosarcoma, two patients; osteosarcoma, two patients; fibrosarcoma, two patients; desmoid tumor, two patients; leiomyosarcoma, one patient; malignant fibrous histiocytoma, one patient; tendon sheath sarcoma, one patient; hemangiosarcoma, one patient; neurinosarcoma, one patient. The ribs were involved in 21 patients, the sternum in five patients, and the soft tissue in 17 patients. Distinction between benign and malignant CWT was not possible using radiographic criteria alone, and diagnosis was always confirmed histologically. Surgical treatment consisted of wide resection in 29 patients (15 benign/14 malignant CWTs), with the use of synthetic mesh in five cases, and excisional or incisional biopsy in 12 patients. There was no perioperative mortality. Two patients with a benign CWT (fibroma, one patient; neurilemoma, one patient) had a local recurrence at 13 and 26 months after resection, respectively, and underwent wide resection (recurrence rate 8.7%). Follow-up at 3-13 years revealed one non-tumor-related death in patients with benign CWT (overall mortality rate 4.3%) and no other local recurrence. The overall 5- and 10-year survival in patients with malignant CWT was 33.3%. Conclusions: We believe that all CWTs should be considered malignant until proven otherwise. Wide resection with tumor-free margins is required in order to provide the best chance for cure in both benign and malignant lesions. (C) 2001 Elsevier Science B.V. All rights reserved.