74例隆突型皮肤纤维肉瘤的治疗与预后分析

Prognostic factors and treatment of 74 patients with dermatofibro sarcoma protuberans

目的 探讨隆突型皮肤纤维肉瘤 (DFSP)的治疗及其影响预后的因素。方法 对 74例经病理证实的隆突型皮肤纤维肉瘤 (DFSP)患者进行回顾性分析。其中 ,72例行广泛切除术 ,2例行局部切除。 5 2例行单纯手术治疗 ,2 2例加术后放疗。放射治疗采用 6Mev电子线 +60 Coγ线 ,或 6Mev电子线 +后装 ,或单纯电子线照射。 17例采用连续照射 ,5例采用分段治疗 ,照射剂量 5 0～ 70Gy。全部患者均未行化疗和其他治疗。以Cox比例风险模型进行多因素分析 ,以Kaplan Meier法计算无复发生存时间 ,以Logrank检验进行结果之间的比较。结果 剔除 2例失访病例 ,全组复发率为 2 8.4 % ,5年无复发生存率为 6 6 .6 % ,10年无复发生存率为 5 2 .5 %。多因素分析结果显示 ,放疗与否和术后病理切缘为独立预后因素。术后放疗组与单纯手术组的 5年无复发生存率分别为 90 .0 %和 5 8.4 % ,10年无复发生存率分别为 83.3%和 4 1.2 % (P <0 .0 5 ) ;病理切缘阴性和阳性的 5年无复发生存率分别为75 .0 %和 5 7.5 % ,10年无复发生存率分别为 5 6 .6 %和 4 1.4 % (P <0 .0 5 )。结论 术后放疗与否和术后病理切缘为DFSP的独立预后因素。

Objective To analyze treatment and prognostic factors of 74 patients with dermatofibro sarcoma protuberans(DFSP). Methods From August 1990 to November 1999, 74 patients with DFSP confirmed pathologically were treated. There were 52 males and 22 females with a median age of 37 years(range 4 to 80 years) on diagnosis. Seventeen patients were treated by extensive excision and 2 by limited excision. Fifty two patients had surgical resection alone(S), and 22 postoperative radiotherapy(S+R)of 50 70 Gy. The multivariate parameters were analyzed using Cox model. Kaplan Meier and Log Rank test were used to evaluate the results of the recurrence free survival. Results The rate of recurrence was 28.4% for all patients. The 5 year recurrence free survival rate (RFSR) was 66.6% and the 10 year RFSR was 52.5%. The 5 year and 10 year in the S group were 58.4% and 41.2%, compared with 90.0% and 83.3% in the S+R group (P<0.05). The 5 year and 10 year RFSR in the pathologically positive margin group were 57.5% and 41.4% respectively, compared with the 75.0% and 56.6% in the pathologically negative group(P<0.05). Multivariate analysis suggested radiotherapy and negative pathological margins were favorable prognostic factors. Conclusion Post operation radiotherapy and pathological margin are the independent prognostic factors.