原发四肢软组织肉瘤的综合治疗

Comprehensive treatment of primary extremity soft tissue sarcomas

软组织肉瘤（ soft tissue sarcoma，STS ）是一组高度异质性不常见的肿瘤，目前已经明确的 STS 亚型有50多种。成人最常见的 STS 依次为：多形性未分化肉瘤、脂肪肉瘤、平滑肌肉瘤、滑膜肉瘤及恶性神经鞘瘤等。儿童最常见的 STS 是横纹肌肉瘤。对于成人 STS 并没有可以被广泛接受的治疗规范。一些预后因素已经明确，包括肿瘤的病理分级、大小、部位及是否发生远处转移等。对于 STS 治疗的一些相关因素尚有争议，如：怎样的外科切缘是安全的？什么时候实施放疗？系统化疗是否可以改善预后？现就近年来国内外有关四肢 STS 治疗的相关现状及最新进展介绍如下。

Sarcoma is a rare solid tumor which roots in different mesenchymal cells, with distinct clinical and pathologic features. Soft tissue sarcoma （ STS ） roots in the fat, muscles, nerves, blood vessels and other connective tissues. The pathogenesis is still unclear. In the diagnosis of STS, the combination of clinical features, imaging and pathology is emphasized. Pathologic evaluation should include the type of STS, grading and staging. Operation is given priority in the comprehensive treatment of STS. According to the pathologic evaluation, clinical stage and the relationship between STS and bones, joints and peripheral nerves and blood vessels, the surgical method is selected. The curative effects of STS could be improved by normative diagnosis and treatment. The importance of a multidisciplinary team （ MDT ） is emphasized in regional cancer center. On the basis of the high-level evidence-based medicine, individualized diagnosis and treatment is the best medical practice.