Is 2 mm a wide margin in high-grade conventional chondrosarcomas of the pelvis?
Is 2 mm a wide margin in high-grade conventional chondrosarcomas of the pelvis?
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DOI：
10.1302/0301-620x.103b6.bjj-2020-1869.r1
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发表时间：
2021-06-01
影响因子：
4.6
通讯作者：
Jeys, L. M.
中科院分区：
文献类型：
--
作者：
Kurisunkal, V;Laitinen, M. K.;Jeys, L. M.
目的：对于高级别盆腔软骨肉瘤（CS），什么样的切缘是安全的，以减少局部复发，目前仍存在争议。本研究的目的是量化什么是一个安全的边缘切除高级别CS的pelvin.MethodsWe回顾性地确定了105非转移性患者与高级别骨盆CS骨谁接受手术（保肢/截肢）之间2000年和2018年。其中男性患者82例（78%），女性患者23例（22%），平均年龄55岁（26至84岁）。大多数患者接受了保肢手术（n = 82; 78%），23例（22%）患者接受了截肢术。总体而言，66例（64%）患者为2级CS，38例（36%）患者为3级CS。对所有患者的分期、盆腔解剖学分类、切除和重建类型、切缘状态、局部复发、远处复发和总生存率进行评估。手术切缘分层为毫米：< 1毫米，> 1毫米，但< 2毫米，和> 2毫米。结果疾病特异性生存（DSS）在5年为69%（95%置信区间（CI）56%至81%）和51%（95% CI 31%至70%）的2级和3级CS，分别（p = 0.092）。2级CS的5年局部无复发生存率（LRFS）为59%（95% CI 45%至72%），3级CS为42%（95% CI 21%至63%）（p = 0.318）。超过2 mm的边缘是LRFS增加的重要预测因素（p = 0.001）。有一种趋势，但没有统计学意义，> 2 mm的边缘是改善DSS的预测因子。局部复发（LR）是一个高度显着的预测DSS，在竞争风险模型分析（p = 0.001）。根据我们的研究，我们得出结论，对于高级别骨盆CS患者，有必要达到至少2 mm的边缘以获得最佳的肿瘤学结局。
AimsControversy exists as to what should be considered a safe resection margin to minimize local recurrence in high-grade pelvic chondrosarcomas (CS). The aim of this study is to quantify what is a safe margin of resection for high-grade CS of the pelvis.MethodsWe retrospectively identified 105 non-metastatic patients with high-grade pelvic CS of bone who underwent surgery (limb salvage/amputations) between 2000 and 2018. There were 82 (78%) male and 23 (22%) female patients with a mean age of 55 years (26 to 84). The majority of the patients underwent limb salvage surgery (n = 82; 78%) compared to 23 (22%) who had amputation. In total, 66 (64%) patients were grade 2 CS compared to 38 (36%) grade 3 CS. All patients were assessed for stage, pelvic anatomical classification, type of resection and reconstruction, margin status, local recurrence, distant recurrence, and overall survival. Surgical margins were stratified into millimetres: < 1 mm; > 1 mm but < 2 mm; and > 2 mm.ResultsThe disease-specific survival (DSS) at five years was 69% (95% confidence interval (CI) 56% to 81%) and 51% (95% CI 31% to 70%) for grade 2 and 3 CS, respectively (p = 0.092). The local recurrence-free survival (LRFS) at five years was 59% (95% CI 45% to 72%) for grade 2 CS and 42% (95% CI 21% to 63%) for grade 3 CS (p = 0.318). A margin of more than 2 mm was a significant predictor of increased LRFS (p = 0.001). There was a tendency, but without statistical significance, for a > 2 mm margin to be a predictor of improved DSS. Local recurrence (LR) was a highly significant predictor of DSS, analyzed in a competing risk model (p = 0.001).ConclusionObtaining wide margins in the pelvis remains challenging for high-grade pelvic CS. On the basis of our study, we conclude that it is necessary to achieve at least a 2 mm margin for optimal oncological outcomes in patients with high-grade CS of the pelvis.