局部复发性软组织肉瘤的疗效及预后

Management and prognosis of patients with locally recurrent soft tissue sarcomas

目的评价局部复发性软组织肉瘤的治疗效果并探讨其预后因素。方法采用单因素和多因素分析方法，对９６例局部复发性软组织肉瘤的临床、病理特征、治疗方法及其对预后的影响进行研究。肿瘤组织学分级为低分级者（Ｇ１）２０例，占２０．８％；高分级者（Ｇ２，３）７６例，占７９．２％。手术方式为广泛切除６６例，局部切除６例，截肢２４例。辅助放疗２４例，辅助化疗３６例。结果本院再次手术后５年局部控制率为７０．１％，５年生存率为５９．１％。多因素分析显示：肿瘤的分级、部位、大小，是影响生存率的独立的预后因素。结论强调对软组织肉瘤的首次合理治疗。广泛切除术的切缘应＞２ｃｍ。局部复发肿瘤经积极治疗仍可获得较满意效果。较有效的综合治疗方案有待进一步探索。

Objective The results and prognositic factors in treating locally recurrent soft tissue sarcoma (STS) of the extremities and trunk were identified.Methods The clinical, pathologic, and therapeutic characteristics of 96 STS patients were investigated using univariate and multivariate analyses. Seventy six patients (79.2%) had high grade sarcoma and 20 patients (20.8%) had low grade sarcoma. Operative procedures were wide excision (surgical margin ≥2 cm) in 66, local excision (surgical margin <2 cm) in 6, and amputation in 24 patients. Adjuvant radiotherapy and chemotherapy was administered in 24 and 36 patients respectively. Results After reoperation of the recurrent tumor, the 5 year local control and overall survival rates were 70.1% and 59.1%, respectively. High grade, large size, and tumor in the upper extremities were associated with decreased overall survival. Conclusion The authors emphasize that the initial management of primary STS should be adequate and suggest that safty margin of ≥2 cm should be adhered to. In patients with local recurrence only, the overall survival may not be adversely affected if the recurrent lesion is properly treated. Investigations of more effective multimodality therapy needs to be done.