软组织肉瘤术后局部复发因素分析

Impact factor analysis of postoperative local recurrence of soft tissue sarcoma

目的探讨软组织肉瘤（soft tissue sarcoma,STS）患者术后局部复发的因素。方法回顾分析1995年至2010年,英国爱丁堡皇家医院手术治疗的79例STS患者的随访结果。男44例,女35例;年龄18-97岁,平均62.9岁。79例随访6-139个月,平均41个月。组织学诊断由2名隶属于英国国家组织病理学专家组的成员来确定。肿瘤分级按Trojani分级评定。Trojani 1级定义为低度恶性,Trojani 2级和3级定义为高度恶性。阳性外科边界的标准是,在组织学切片上,发现切除边缘任何部位存在肿瘤细胞。结果本组79例中,21例阳性边界者14例复发,7例未复发;58例阴性边界者9例复发,49例未复发（P〈0.0001,OR=10.9）。53例高度恶性者20例复发,33例未复发;26例低度恶性者,3例复发,23例未复发（P=0.016,OR=4.6）。43例进行辅助治疗者19例复发,24例未复发;36例非辅助治疗者4例复发,32例未复发（P=0.001,OR=6.3）。17例肿瘤转移者8例复发,9例未复发;62例未转移者15例复发,47例未复发（P=0.07,OR=2.8）。肿瘤组织学分级、阳性边界和是否进行辅助治疗是局部复发的相关因素;肿瘤是否转移与局部复发无相关性。高度恶性肿瘤是低度恶性肿瘤的5.2倍,阳性边界是阴性边界的3.3倍,是导致局部复发的独立危险因素。结论外科边界和肿瘤组织学级别是导致局部复发的最重要影响因素。高度恶性肿瘤患者的阳性边界通常会提高肿瘤的复发几率。

Objective To analyze the factors that lead to postoperative local recurrence of soft tissue sarcoma.Methods A retrospective analysis of a sequential series of 79 patients who had undergone surgical resection of soft tissue sarcomas in Royal Infirmary of Edinburgh between 1995 and 2010 was conducted.Forty-four males and 35 females with a mean age of 62.9 years（ range：18-97 years）.Mean follow-up was 41 months（ range：6-139 months）.Histological diagnosis was confirmed by 2 pathologist members of national sarcoma histopathology panel（ UK）.Tumour grade was assessed using the Trojani grade system.Trojani grade 1 STS was defined as low grade;grade 2 and 3 were defined as high grades.Surgical margins were defined as positive if tumour cells were found at any surgical resection margins in histological sections.Results In the series of 79 cases,14 of 21 patients with positive margin recurred,7 cases without recurrence;9 of 58 cases with negative margin recurred,49 cases without recurrence（ P〈0.0001,OR=10.9）.Twenty of 53 cases with high-grade recurred,33 cases without recurrence;3 of 26 cases with low-grade recurred,23 cases without recurrence（ P=0.016,OR=4.6）.Nineteen of 43 cases with adjuvant therapy recurred,24 cases without recurrence;4 of 36 cases with non-adjuvant therapy recurred,32 cases without recurrence（ P=0.001,OR=6.3）.Eight of 17 cases with metastasis recurred,9 cases without recurrence;15 of 62 cases with nonmetastasis recurred,47 cases without recurrence（ P=0.07,OR=2.8）.Histological grade,positive margin and use of adjuvant therapy were the only factors associated with an increased risk of local recurrence.An association with metastasis at presentation was not statistically significant.High grade tumours gave odds ratio of recurrence of 5.2 and positive margins gave odds ratio of 3.3,both were significant independent risk factors of local recurrence.Conclusions Surgical margin and histological grade are the most important factors leading to local recurrence.High-grade tumors with positive margins generally increase the risk of recurrence.