Identification of predictors for wound complications following preoperative or postoperative radiotherapy in extremity soft tissue sarcoma
Identification of predictors for wound complications following preoperative or postoperative radiotherapy in extremity soft tissue sarcoma
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DOI：
10.1016/j.ejso.2018.02.002
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发表时间：
2018-06-01
期刊：
影响因子：
3.8
通讯作者：
Been, Lukas B.
中科院分区：
文献类型：
--
作者：
Stevenson, Marc G.;Ubbels, Jan F.;Been, Lukas B.
前言：在四肢软组织肉瘤(EST)中，除保肢手术(LSS)外，还采用外照射(EBRT)。本研究旨在找出EST中EBRT和LSS术后重大伤口并发症(MWC)发生的预测因素。方法：这项回顾性研究包括2005-2017年间接受EBRT和LSS治疗的EST患者。研究分为两组：I组包括术前接受放射治疗的患者，而II组包括术后接受EBRT的患者。结果：127例患者中，I组58例(45.7%)，II组69例(54.3%)。两组患者在肿瘤大小和分级、组织学亚型和总放疗剂量等基线特征上存在差异。I组23例(39.7%)和II组14例(20.3%)发生MWC(p=0.02)。术前EBRT被确定为MWC发生的独立预测因子，OR 2.75(95%CI 1.21-6.26)，p=0.02。此外，年龄(OR 1.02(0.99-1.04))、伤口延迟闭合(OR 3.20(0.64-16.02))和手术切缘阴性(OR 2.26(0.72-7.11))的患者有增加MWC风险的趋势。该模型的曲线下面积(AUC)为0.68(0.57-0.79)。结论：本研究证实了EST术前EBRT后MWC风险的增加。重要的是要仔细权衡MWC的风险和预期的长期功能结果，并在治疗前考虑在个体化的多学科肿瘤委员会中自由使用一期整形外科重建。(C)2018年爱思唯尔有限公司、类似于癌症外科协会的BASO和欧洲外科肿瘤学学会。版权所有。
Introduction: In extremity soft tissue sarcoma (ESTS), external beam radiotherapy (EBRT) has been used in addition to limb-sparing surgery (LSS). This study aims to identify predictors for major wound complication (MWC) development following EBRT and LSS in ESTS.Methods: This retrospective study includes ESTS patients treated with EBRT and LSS between 2005 and 2017. Two groups were formed; Group I included preoperatively irradiated patients, whereas Group II included patients who underwent postoperative EBRT. Multivariate logistic regression analyses were performed to create a prediction model for MWC development.Results: One hundred twenty-seven patients were included, 58 patients (45.7%) in Group I and 69 patients (54.3%) in Group II. Some differences in baseline characteristics were found between the groups, e.g. in tumor size and grade, histological subtype and total RT dose. Twenty-three patients (39.7%) in Group I and 14 patients (20.3%) in Group II developed a MWC (p = 0.02). Preoperative EBRT was identified as independent predictor for MWC development, OR 2.75 (95%Cl 1.21-6.26), p = 0.02. Furthermore, a trend towards an increased MWC risk was shown for patients' age (OR 1.02 (0.99-1.04)), delayed wound closure (OR 3.20 (0.64-16.02)) and negative surgical margins (OR 2.26 (0.72-7.11)). The area under the curve (AUC) of the model was 0.68 (0.57-0.79).Conclusions: This study corroborates the increased MWC risk following preoperative EBRT in ESTS. It remains important to carefully weigh the MWC risk against the expected long-term functional outcome, and to consider the liberal use of primary plastic surgical reconstructions in an individualized multi-disciplinary tumor board prior to treatment. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.