躯干及四肢平滑肌肉瘤的临床特征及预后影响因素分析

Clinic features and prognostic factors of leiomyosarcomas of trunk and extremities

目的探讨躯干及四肢平滑肌肉瘤(LMS)的临床特征及预后影响因素。方法回顾性分析该院2006年1月至2018年7月收治的33例躯干及四肢LMS患者的临床资料和随访结果。结果本组患者中,男21例,女12例,年龄24~76岁,中位年龄59岁;发病部位躯干9例,四肢24例。肿瘤最大直径1.5~10.0 cm,≤5 cm者20例,>5 cm者13例;1例行姑息手术,其余32例行扩大切除术(切缘均为阴性)。AJCC分期为Ⅰ期13例,Ⅱ期11例,Ⅲ期6例,Ⅳ期3例。免疫组织化学显示SMA阳性20例,Desmin阳性11例,Ki-67≥20%者16例。辅助治疗16例,转移11例。随访时间12~126个月,中位随访时间62个月,中位生存时间35个月。3年和5年生存率分别为66%、61%。单因素分析发现,肿瘤大小(χ^2=6.589,P=0.010)、AJCC分期(χ^2=14.476,P=0.002)、Desmin的表达(χ^2=4.536,P=0.033)、Ki-67的表达(χ^2=8.375,P=0.004)、转移(χ^2=4.049,P=0.044)是影响LMS患者5年生存率的因素。多因素分析发现,AJCC分期为影响LMS患者预后的独立危险因素(RR=2.373,P=0.047)。结论躯干及四肢LMS患者术后复发率和转移率较高,预后较差。Desmin、Ki-67的阳性表达或可作为评价LMS患者预后的潜在指标。

Objective To summarize the clinical characteristics of patients with leiomyosarcoma(LMS)of the trunk and extremities and analyze the prognostic factors.Methods The clinic data and follow-up results of 33 patients with LMS of the trunk and extremities from January 2006 to July 2018 were retrospectively analyzed.Results There were 21 males and 12 females,the age ranged from 24 to 76 years and the median age was 59 years old.Nine lesions were located in the trunk and 24 in the extremities.The maximum diameter of the tumor is 1.5-10.0 cm,20 cases presented lesions with diameters≤5 cm,and 13 cases presented lesions with diameters>5 cm.32 cases were performed extended excision of tumors(all cutting edges were negative)and 1 case underwent palliative resection.A total of 13 cases were AJCC stageⅠ,11 cases were stageⅡ,6 cases were stageⅢand 3 cases were stageⅣ.Immunohistochemistry showed SMA positive in 20 cases,Desmin positive in 11 cases and Ki-67 positive≥20%in 16 cases.Adjuvant therapy was used in 16 cases and metastasis in 11 cases.The follow-up time was 12-126 months,the median follow-up time was 62 months,and the median survival time was 35 months.The 3-year survival rate and 5-year survival rate was 66%and 61%,respectively.Univariate analysis showed that tumor size(χ^2=6.589,P=0.010),AJCC stage(χ^2=14.476,P=0.002),Desmin(χ^2=4.536,P=0.033),Ki-67(χ^2=8.375,P=0.004)and metastasis(χ^2=4.049,P=0.044)were associated with 5-year survival rate.The multivariate analysis showed that AJCC stage was an independent prognostic factor(RR=2.373,P=0.047).Conclusion The recurrence and metastasis rate of LMS of trunk and extremities were higher and the prognosis was poor.The positive expression of Desmin and Ki-67 may be potential prognostic indicators for LMS patients.