原发肢体软组织肉瘤208例预后的影响因素分析

Retrospective analysis and prognostic factors of 208 cases of primary soft tissue sarcoma of extremity

目的 探讨影响肢体软组织肉瘤预后的因素,特别是外科治疗对其预后的影响.方法 回顾性研究208例手术治疗的肢体软组织肉瘤患者,其中男性128例,女性80例,平均年龄46岁（9～98）岁.分析患者是否初治、肿瘤的大小（＜5 cm、5～10 crn、＞10 cm）、深度（深筋膜深层、浅层）、组织学分型（脂肪肉瘤、恶性纤维组织细胞瘤、滑膜肉瘤、纤维肉瘤、恶性神经鞘瘤、其他肿瘤）、病理分级（FNCLCC系统Ⅰ、Ⅱ、Ⅲ级）、外科边界（囊内切除、边缘切除、广泛切除、根治切除）以及辅助治疗等因素对患者预后的影响.结果 中位随访时间37.5个月（1.3 ～ 128.1个月）,总体3年、5年生存率77％和75％;复发率28％和37％;转移率35％和43％.肿瘤大小、病理分级和术前是否有转移可以独立影响生存率（x2=18.813、24.849、21.107,均P＜0.05）;是否为初治病例、组织学分型可以独立影响复发率（x2=21.915、12.192,P＜0.05）;病理分级可以独立影响转移率（x2=7.714,P＜O.05）.手术外科边界可以独立影响局部复发率和转移率（x2=19.610、9.272,P＜0.05）.结论 外科边界独立影响局部复发率和远处转移率,从而间接影响生存率.尤其对无转移的初次治疗的软组织肉瘤,手术是首选方案,手术外科边界达到广泛切除或根治性切除将明显改善患者的预后.

Objective To investigate the prognosis factors of soft tissue sarcoma,especially the impact of surgical treatment on the prognosis.Methods We retrospectively reviewed 208 surgically treated patients.There were 128 male and 80 female.The average age was 46 ranged from 9 to 98 years old.Possible factors of whether the patient firstly treated in our hospital,the tumor size （ 〈 5 cm,5 ～ 10 cm,〉 10 cm）,tumor depth （superficial deep fascia,under the deep fascia）,histological type （such as adipose sarcoma,malignant fibrous histiocytoma,synovial sarcoma,fibrous sarcoma,malignant peripheral nerve sheath tumors,other tumors ）,tumor grade （FNCLCC Ⅰ,Ⅱ,Ⅲ ）,surgical margin （intralesional,marginal,wide,radical） and adjuvant therapy on the prognosis of patients were analyzed.Results The median follow-up was 37.5 ranged from 1.3 to 128.1 months.The overall 3-year and 5-year survival were 77% and 75%.The overall 3-year and 5-year recurrence rate were 28% and 37%.The overall 3-year and 5-year metastasis rate were 35% and 43%.Tumor size,tumor grade and metastasis or not independently affected survival （x2 =18.813,24.849 and 21.107,all P 〈0.05）.Whether the patient firstly treated in our hospital and histological type independently affect the local recurrence （x2 =21.915,12.192,both P 〈0.05 ） ; histological grade can independently affect the metastasis （ x2 =7.714,P 〈 0.05 ）.Surgical margin alone affected the local recurrence and metastasis （x2 =19.610,9.272,both P 〈0.05）.Conclusions Surgical margin independently affected local recurrence and distant metastasis,and thus indirectly affect the survival of soft tissue sarcoma.In particular,the primary choice for treatment of soft tissue sarcoma without metastasis should be surgery.Wide or radical margin could significantly improve the prognosis of soft tissue sarcoma patients.