Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children With Chest Wall Sarcoma: A Pediatric Surgical Oncology Research Collaborative Study.
Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children With Chest Wall Sarcoma: A Pediatric Surgical Oncology Research Collaborative Study.
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DOI：
10.1097/sla.0000000000004579
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发表时间：
2022-12-01
影响因子：
9
通讯作者：
Lautz TB
中科院分区：
文献类型：
--
作者：
Harris CJ;Helenowski I;Murphy AJ;Mansfield SA;LaQuaglia MP;Heaton TE;Cavalli M;Murphy JT;Newman EA;Overmen RE;Kartal TT;Cooke-Barber J;Donaher A;Malek MM;Kalsi R;Kim ES;Zobel MJ;Goodhue CJ;Naik-Mathuria BJ;Jefferson IN;Roach JP;Mata C;Piché N;Joharifard S;Sultan S;Short SS;Meyers RL;Bleicher J;Le HD;Janek K;Bütter A;Davidson J;Aldrink JH;Richards HW;Tracy ET;Commander SJ;Fialkowski EA;Troutt M;Dasgupta R;Lautz TB
确定肿瘤特征和治疗方法对胸壁肉瘤儿童（1）局部复发，（2）脊柱侧凸发展和（3）患者报告的生活质量的影响。患有胸壁肉瘤的儿童需要多模式治疗，包括化疗，手术和/或放疗。尽管积极的治疗使他们面临功能障碍和脊柱侧凸的风险，但这些患者也有局部复发的显著风险。对2008年至2017年期间在17个儿科外科肿瘤学研究协作机构治疗的175名胸壁肉瘤儿童（中位年龄13岁）进行了多机构审查。使用PROMIS调查前瞻性评估患者报告的生活质量。最常见的诊断是尤文肉瘤（67%）和骨肉瘤（9%）。手术切除率为85%，放疗率为55%。平均切除2根肋骨（IQR=1-3），切除的肋骨数量与边缘状态无关（p=0.36）。局部复发发生率为23%，切缘状态是唯一的预测因素（HR 2.24，p=0.039）。中位随访5年，13%的患者发生脊柱侧凸（中位Cobb角26），5%的患者需要脊柱矫正手术。脊柱侧凸与后肋骨切除（HR 8.43; p=0.003）和切除的肋骨数量增加（HR 1.78; p=0.02）相关。总体而言，胸壁肿瘤切除术后患者报告的生活质量未受损。四分之一的儿童胸壁肉瘤会发生局部复发，并且与肿瘤类型无关。13%的患者发生脊柱侧凸，但患者报告的生活质量非常好。本研究是一项关于儿童胸壁肉瘤局部复发和功能结局的多机构综述。局部复发发生在23%的儿童，是独立的肿瘤类型，但与边缘状态。13%的患者发生脊柱侧凸，但患者报告的生活质量非常好。
To determine the impact of tumor characteristics and treatment approach on (1) local recurrence, (2) scoliosis development and (3) patient-reported quality of life in children with sarcoma of the chest wall. Children with chest wall sarcoma require multimodal therapy including chemotherapy, surgery and/or radiation. Despite aggressive therapy which places them at risk for functional impairment and scoliosis, these patients are also at significant risk for local recurrence. A multi-institutional review of 175 children (median age 13 years) with chest wall sarcoma treated at seventeen Pediatric Surgical Oncology Research Collaborative institutions between 2008–2017 was performed. Patient-reported quality of life was assessed prospectively using PROMIS surveys. The most common diagnoses were Ewing sarcoma (67%) and osteosarcoma (9%). Surgical resection was performed in 85% and radiation in 55%. A median of 2 ribs were resected (IQR=1–3), and number of ribs resected did not correlate with margin status (p=0.36). Local recurrence occurred in 23% and margin status was the only predictive factor (HR 2.24, p=0.039). With a median follow-up of 5 years, 13% developed scoliosis (median Cobb angle 26) and 5% required corrective spine surgery. Scoliosis was associated with posterior rib resection (HR 8.43; p=0.003) and increased number of ribs resected (HR 1.78; p=0.02). Overall, patient-reported quality of life is not impaired following chest wall tumor resection. Local recurrence occurs in one-quarter of children with chest wall sarcoma and is independent of tumor type. Scoliosis occurs in 13% of patients, but patient-reported quality of life is excellent. This study is a multi-institutional review of local recurrence and functional outcomes for children with chest wall sarcoma. Local recurrence occurs in 23% of children and is independent of tumor type but correlates with margin status. Scoliosis occurs in 13% of patients, but patient-reported quality of life is excellent.