软组织恶性纤维组织细胞瘤的治疗策略和预后分析

Analysis of therapeutic strategies and prognostic factors of malignant fibrous histiocytoma of soft tissue

目的 分析软组织恶性纤维组织细胞瘤的治疗策略及预后相关因素.方法 回顾性分析1999年12月至2010年10月收治的78例软组织恶性纤维组织细胞瘤患者的临床资料,并对性别、年龄、肿瘤部位、肿瘤大小等9项可能影响预后的因素进行统计学分析.结果 60例患者获得随访,随访时间6～131个月,平均35.5个月.l、3、5年总体生存率分别为84.9％、72.9％和56.9％.术后局部复发20例（33.3％）,中位局部复发时间为11.5个月（1～72个月）.术后转移9例（15.0％）,中位转移时间为7个月（1～26个月）.单因素分析表明,就诊情况（初治组或复发治疗组）、肿瘤大小和外科边界与生存率有相关性（均P ＜0.05）,外科边界、放疗与局部复发有相关性（P =0.000、0.039）,外科边界与远处转移有相关性;多因素分析显示,外科边界是影响生存率（P =0.002,OR=5.753,95％CI1.904～17.386）和局部复发（P=0.000,RR =0.044,95％CI0.010 ～0.188）的独立危险因素.结论 外科边界是影响生存率和局部复发的独立危险因素.采取以手术为主联合放疗的综合治疗,方能减少复发、提高生存率.

Objective To assess the therapeutic strategies and risk factors of malignant fibrous histiocytoma of soft tissue.Methods The 78 cases with malignant fibrous histiocytoma of soft tissue treated at Muscular Skeletal Tumor Center of People＇s Hospital,Peking University from December 1999 and October 2010 were retrospected.Univariate and multivariate analyses were performed to determine the probable risk factors including sex,age,tumor location,tumor size and so on.Results All 60 cases were followed up ranged from 6 to 131 months （ medium 35.5 months）.The 1-,3-,5-year overall survival rate was 84.9%,72.9% and 56.9% respectively.Local recurrence rate is 33.3% （20 cases） with a median time of 11.5 months （ 1 to 72 months） and metastatic rate is 15.0% （9 cases） with a median time of 7 months （ 1 to 26 months）.Univariate analysis indicated that condition of presentation （ primary case or recurrence case）,tumor size and surgical margin were significantly related to survival rate （ all P 〈 0.05,Kaplan-Meier Logrank test）,surgical margin and radiotherapy related to local recurrence rate （P value were 0.000 and 0.039 respectively）,and surgical margin related to metastatic rate.Multivariate analysis showed that surgical margin was independent risk factors for survival rate （ P =0.002,OR =5.753,95% CI 1.904-17.386） and local recurrence rate （P =0.000,RR =0.044,95% CI 0.010-0.188 ）.Conclusions Surgical margin was independent risk factors for survival rate and local recurrence rate.Comprehensive therapy of surgery followed by radiotherapy can improve survival rate,reduce local recurrence rate.