腹部恶性纤维组织细胞瘤的外科治疗和预后相关因素分析

An analysis of prognostic factors for abdominal malignant fibrous histiocytoma

目的总结分析腹部恶性纤维组织细胞瘤(MHF)的外科治疗策略及预后相关因素。方法回顾性分析1980年7月至2003年11月间51例腹部恶性纤维组织细胞瘤患者的临床资料。结果术后48例患者获得随访,随访时间为24-304个月,35例患者复发、转移,术后单纯局部复发 15例(29．4％),出现肺及胸膜转移8例(15．7％)、肝转移4例(7．8％)、骨转移6例(11．7％)、肾脏转移2例(3．9％),复发合并转移7例(13．7％)。术后1、3、5年无瘤生存率分别为70．6％、43．1％和 29．4％,累计生存率分别为74．5％、52．9％和31．4％。结论腹部恶性纤维组织细胞瘤侵袭性强, 复发率高,病理分级差,手术完整切除、术后辅以放疗有助于提高患者的远期生存率。

Objective To assess the therapeutic strategies and prognostic factors that influence clinical outcome of malignant fibrous histiocytoma （MFH） of the abdomen. Methods Between Jul 1980 and Nov 2003, 51 intraabdominal MFH patients undergoing resection were retrospectively analyzed. Results Postoperative recurrence developed in 35 patients, with local recurrence in 15 （29. 4% ）, distant metastasis in 20, including lung metastasis in 8 （ 15.7% ） , liver metastasis in 4 （ 7.8% ） , and bone metastasis in 6 （11.7%）. The 1-, 3- and 5-year disease-free survival rate was 70.6%, 43.1% and 29.4% , respectively, and the 1-, 3- and 5-year cumulative survival rate was 74. 5% , 52. 9% and 31.4% , respectively. Conclusions Intraabdominal MFH is a rare entity with high biological aggressiveness and high metastasis potential. Surgical resection has generally been accepted as the treatment of choice for MFH, at the same time, there appears to be a role for radiation therapy, in combination with surgery for better local control, particularly in high-grade lesions.