滑膜肉瘤预后相关因素分析

Evaluation of prognostic factors for synovial sarcoma

目的 分析影响滑膜肉瘤患者预后的相关因素.方法 回顾性分析1997年9月至2008年9月就诊的66例滑膜肉瘤患者中52例获得随访的患者的临床资料.其中男性28例,女性24例;发病年龄11～71岁,均以无痛性肿块入院.通过随访了解肿瘤学预后,明确3、5年总体生存率及局部复发率.通过回顾病例,分析年龄、性别、肿瘤部位、肿瘤直径、外科边界、病理亚型、局部治疗方式、是否侵及骨与神经血管以及是否化疗9项因素对总体生存率的影响.利用Kaplan-Meier生存分析确定对生存有影响的单个因素,并通过Cox回归分析明确影响预后的独立危险因素.结果 52例患者获得随访,随访率78.8％;随访时间6 ～ 88个月,中位随访时间32个月.患者5年总体生存率为30.3％,局部复发率为32.7％,中位复发时间16个月.单因素分析结果提示：肿瘤直径＜5 cm、取得广泛外科边界、肿瘤位于四肢以及采取广泛切除联合局部放疗的患者预后较好（P＜0.05）.多因素分析显示肿瘤直径,部位以及是否取得广泛外科边界是影响预后的独立危险因素.结论 肿瘤直径、部位以及是否取得广泛外科边界是影响预后的独立危险因素.

Objective To determine the independent prognostic factors of primary synovial sarcoma.Methods The clinical data of 52 patients followed up from 66 patients with synovial sarcoma treated between September 1997 and September 2008 was analyzed retrospectively.There were 28 male and 24 female patients aged from 11 to 71 years old.Three and five-year overall survival （OS）,recurrence rate and 9 prognostic factors were analyzed in this study.Univariate and multivariate analysis were performed to determine the prognostic factors of OS.Results Fifty-two patients were followed up with the follow-up time ranged from 6 to 88 months （median 32 months）.The 3-,5-year overall survival rate and local recurrence rate were 52.8%,30.3% and 32.7% respectively.Univariate showed tumor size 〈5 cm,tumor located at extremities,adequate surgical margin and radical resection combined with radiotherapy had better survival rate （P 〈 0.05 ）.Multivariate analysis demonstrated that tumor size,primary site and adequate surgical margin were independent prognostic factors for OS.Patients received radical resection combined with radiotherapy have longer median relapse time（25 months） compared with marginal resection combined with radiotherapy（ 18 months） and single radical resection （ 12 months）.Thirty-five （67%） patients were treated with chemotherapy and seventeen （33%） patients received no chemotherapy for the primary tumor.Treatment with chemotherapy was not associated with an improved OS （ P =0.52 ）.Conclusions The independent prognostic factors of synovial sarcoma are tumor size,primary site and adequate surgical margin.Doxorubicin and ifosfamide based chemotherapy was not associated with an improved OS in patients with synovial sarcoma.Radical resection combined with radiotherapy can best control local condition.