软组织肉瘤的诊断与综合治疗

The diagnosis and multidisciplinary treatment of soft tissue sarcoma

软组织肉瘤(STS)是一种来源广泛、组织学各异、罕见的恶性肿瘤。其诊断的基础依赖于光镜下的形态表现,特殊染色、免疫组化及电镜观察是其病理诊断的有益补充,结合临床如年龄、肿瘤大小、部位、生长方式等,以综合判断从而能做出正确的诊断。外科手术是治疗软组织肉瘤的主要方式,辅助放疗能控制肿瘤的局部复发,现代治疗软组织肉瘤,尤其病灶位于四肢者,崇尚综合治疗。辅助化疗的作用仍有争议,但有Meta分析证实辅助化疗能提高无病生存和总生存率,特别是位于四肢者。化疗对晚期STS有一定作用,以ADM、IFO为主的强化治疗能产生较好的疗效,但选择标准更为严格。开发新的靶向治疗药物是改善STS预后的关键。

The soft-tissue sarcomas(STS)are a group of rare but anatomically and histologically diverse neoplasms.Its diagnosis is largely based on the morphologic presentation in microscopy,and special staining techniques,ultrastructure,and immunohistochemistry are useful to diagnosis,while final decision can be made in combination with clinical characteristics-age,size of mass,location,and the growth pattern of tumor.The treatment is primarily surgical resection with a margin of normal tissue.Postoperative adjuvant radiotherapy improved local control,with little impact on survival.Contemporarily,multimodality therapy is advocated.The role of chemotherapy in the adjuvant setting remains controversial.[JP2]Recent meta-analysis of randomized prospective trials[JP] shows reduced local and distant relapse and a trend towards improved survival rate after adjuvantchemotherapy,especially for the STS of extremities.Chemotherapy has some effects on the local advanced or metastatic STS,and a better control rate can be obtained with the intensive chemotherapy based on adriamycin and/or ifosfomide,which the selection criteria is more strict.Exploring the novel targeted agents is the key to improving the prognosis of STS.