软组织骨肉瘤10例报道及文献复习

Diagnosis and treatment of soft tissue osteosarcoma:A report of 10 cases and literature review

目的：探讨软组织骨肉瘤的临床表现、治疗方法、疗效及预后。方法：回顾性分析浙江大学医学院附属第二医院骨科2002年1月-2014年12月收治的10例软组织骨肉瘤患者的临床病理资料和随访资料。结果：10例软组织骨肉瘤患者中,男性6例,女性4例;7例的肿瘤位于肢体,1例位于腹股沟,1例位于髂部,1例位于髋部;肿瘤位于深筋膜深层7例,位于深筋膜浅层3例;4例的肿瘤最大直径〉10 cm,4例的肿瘤直径为5~10cm,2例的肿瘤直径〈5 cm;9例为高级别骨肉瘤,1例为中至低级别骨肉瘤。所有患者均接受手术切除,4例接受术后化疗,无患者接受术后放疗。5例出现局部复发,其中4例伴远处转移,无单纯转移患者。3例死于肺转移。结论：软组织骨肉瘤的发病率低,恶性程度高,容易发生局部复发及远处转移,死亡率高。广泛手术切除是软组织骨肉瘤主要的治疗手段,其预后与手术切除范围及肿瘤大小密切相关;化疗的作用尚不明确;一般不给予放疗。

Objective： To explore the clinical manifestations, treatment methods, therapeutic efficacy and outcomes of soft tissue osteosarcoma. Methods： The clinical records and follow-up information of 10 patients with soft tissue osteosarcoma admitted in Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine from January 2002 to December 2014 were retrospectively analyzed. Results： Of 10 patients with soft tissue osteosarcoma, six were male, and four were female; 7 patients had tumors located in limbs, and 3 had tumors located in groin, ilium and hip, respectively; 7 tumor lesions were located in superficial layer of deep fascia, and 3 were located in deep layer; concerning tumor size, the tumor diameter was larger than 10 cm in 4 cases , 5-10 cm in 4 cases, and shorter than 5 cm in 2 cases; regarding to pathologic grading, 9 cases were high-grade osteosarcoma, and 1 case was low to medium grade. All patients underwent tumor resection, of which, 4 cases received post- operative chemotherapy, and radiotherapy was not utilized. Three cases suffered from local recurrence, in which, 4 cases also had distant metastasis; no metastasis alone was observed. Four cases died of lung metastasis. Conclusion： Soft tissue osteosarcoma is characterized by low morbidity, high malignant grade, high local recurrence rate and distant metastasis rate, as well as high mortality. Extensive resection is the most important therapeutic strategy for soft tissue osteosarcoma, and its outcomes are related to resection extent and tumor size. Chemotherapy is not a validated treatment strategy, and radiotherapy is also seldom utilized in treatment of soft tissue osteosarcoma.