胸壁骨与软组织肉瘤46例预后分析

Prognosis of the chest wall bone and soft tissue sarcomas:an analysis of 46 cases

目的探讨胸壁骨与软组织肉瘤的临床表现、治疗及预后。方法分析2000年1月至2004年6月复旦大学附属肿瘤医院手术治疗的46例胸壁骨与软组织肉瘤的临床资料。46例病人中,28例为该院初次治疗,18例为外院切除术后复发的再次手术治疗;其中18例为经胸手术,9例需行胸壁缺损修复;全部病人均进行随访,平均随访26.5个月。用寿命表法进行生存分析,Ghan比分法进行单因素生存曲线比较,Cox模型进行多因素生存分析。结果全组3年无病存活率为48.43%。单因素预后分析发现,该院初次手术与再次手术,3年无病存活率分别为73%与15%;病理分级低度恶性与高度恶性的,3年无病存活率分别为74%与28%;切缘阴性的与阳性的,3年无病存活率分别为64%与13%;未补充放疗与补充放疗的,3年无病存活率分别为60%与33%;以上差异均有显著性意义,P<0.05;经胸手术则与预后无关。多因素逐步回归分析,提示初次手术或再次手术、病理分级及切缘情况为独立的预后指标。结论胸壁骨与软组织肉瘤的预后与手术的彻底程度、肿瘤的病理特性相关。治疗应选择手术治疗,初次治疗及手术切缘阴性是影响胸壁骨与软组织肉瘤预后的关键因素。

Objective To discuss the clinical behavior and treatment of the patients with chest wall bone and soft tissue sarcomas, and to evaluate prognostic factors for the patients, Methods The clinical data of 46 patients with chest wall and soft tissue sarcomas performed surgical operation between January 2000 and June 2004 in Cancer Hospital of Fudan University were analyzed. Among all the patients,28 patients were treated for the first time, and other 18 patients were treated in other hospital previously and recurred. Eighteen patients were performed thoracectomy, and 9 patients were performed chest wall reconstruction. All the patients were followed up. The average follow-up period was 26.5 months. Life table method was used for the survival analysis. Results The 3-years disease-free survival rate was 48.43%. The surgical operation time, malignant grade, marginal states and post-operative radiotherapy were prognostic factors for univariate analyses. The primary surgically treated patients had a better prognosis than the recurred patients, and 3-years disease-free survival rates were 73% and 15%, P =0. 0032. The patients with low histologic grade had a better prognosis than with high grade ,and 3-years disease-free survival rates were 74% and 28% , P = 0. 0008. The patients with negative margin had a better prognosis than with positive margin, and 3-years disease-free survival rates were 64% and 13%, P = 0. 0005. The patients without post-operative radiotherapy had a better prognosis than with post-operative radiotherapy, and 3-years disease-free survival rates were 60% and 33% , P = 0. 0363. The surgical time, malignant grade, marginal states were independent predicators for the risk of recurrence at multivariate analyses. Conclusion The disease-free survival of the chest wall bone and soft tissue sarcomas is related to surgical treatment and tumor malignant grade. The chest wall bone and soft tissue sarcomas could be controlled by proper surgical resection.