Localized extremity soft tissue sarcoma: Improved knowledge with unchanged survival over time
Localized extremity soft tissue sarcoma: Improved knowledge with unchanged survival over time
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DOI：
10.1200/jco.2003.02.026
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发表时间：
2003-07-15
影响因子：
45.3
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Weitz, J;Antonescu, CR;Brennan, MF
目的：本研究的目的是明确四肢软组织肉瘤(STS)患者的存活率在过去20年中是否有所改善。患者和方法：1982年1月至2001年12月，1706名四肢软组织肉瘤患者在我所接受治疗，并进行前瞻性随访。从这个队列中，我们选择了1261名接受了完全肉眼切除的患者，他们患有下列组织病理学之一：纤维肉瘤、脂肪肉瘤、平滑肌肉瘤、恶性纤维组织细胞瘤或滑膜肉瘤。中位随访时间为55个月。结果：5年疾病相关精算生存率为79%(1982~1986年为78%，1986~1991年为79%，1992~1996年为79%，1997~2001年为85%，P=0.0 5)。对于高危患者(高级别，10厘米，深层肿瘤；n=247)，5年疾病特定生存率为51%(1982-1986年治疗的患者为50%，1986-1991年治疗的患者为45%，1992-1996年治疗的患者为52%，1997-2001年治疗的患者为61%；P=0.0 0 1)。多因素分析表明，肿瘤深度、大小、分级、显微切缘状况、患者年龄、临床表现状态(原发肿瘤与局部复发)、肿瘤部位(近端与远端)以及某些组织病理学亚型是影响疾病特异性生存的重要预后因素；但治疗时间不是显著的预后因素。结论：对已知危险因素分层的四肢STS患者的预后在过去20年中没有改善，表明目前的治疗已达到疗效极限。(C)2003年，由美国临床肿瘤学会提供。
Purpose : The objective of this study was to define whether survival of patients with extremity soft tissue sarcoma (STS), stratified for known risk factors, has improved over the last 20 years.Patients and Methods: From January 1982 to December 2001, 1,706 patients with primary and recurrent STS of the extremities were treated at our institution and were prospectively followed. From this cohort, we selected 1,261 patients who underwent complete macroscopic resection and had one of the following histopathologies: fibrosarcoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, or synovial sarcoma. Median follow-up was 55 months. Patient, tumor, and treatment factors were analyzed as prognostic factors.Results: The 5-year disease-specific actuarial survival was 79% (78% for patients treated from 1982 to 1986, 79% for patients treated from 1986 to 1991, 79% for patients treated from 1992 to 1996, and 85% for patients treated from 1997 to 2001; P = not significant). For high-risk patients (high-grade, > 10 cm, deep tumors; n = 247), 5-year disease-specific survival was 51% (50% for patients treated from 1982 to 1986, 45% for patients treated from 1986 to 1991, 52% for patients treated from 1992 to 1996, and 61% for patients treated from 1997 to 2001; P = not significant). Tumor depth, size, grade, microscopic margin status, patient age, presentation status (primary tumor versus local recurrence), location (proximal versus distal), and certain histopathologic subtypes were significant prognostic factors for disease-specific survival on multivariate analysis; however, time period of treatment was not.Conclusion: Prognosis of patients with extremity STS, stratified for known risk factors, has not improved over the last 20 years, indicating that current therapy has reached the limits of efficacy. (C) 2003 by American Society of Clinical Oncology.