手术治疗原发性肠系膜肉瘤患者生存预后的影响因素分析

Analysis of prognostic factors of patients with primary mesenteric sarcoma treated by surgery

目的分析手术治疗原发性肠系膜肉瘤患者的生存预后及其影响因素。方法回顾性分析2004年1月至2017年12月山东省临沂市肿瘤医院收治的147例原发性肠系膜肉瘤患者的临床资料与随访资料,记录患者的临床病理特征、术后随访及总体生存情况,总体生存情况采用无病生存率和疾病特异性生存率进行评价,并分析患者预后的影响因素。结果147例患者中,106例患者肿瘤大小≥10cm,116例患者为高度恶性,疾病首发症状多数为腹部肿块,113例患者术后复发。患者的术后随访时间为10~130个月,中位随访时间为58.0个月,复发和转移131例,死亡131例,均因腹腔广泛转移导致多脏器功能衰竭而死亡。患者术后1年、3年、5年的无病生存率分别为85.0%、59.9%、23.1%;1年、3年、5年的疾病特异性生存率分别为93.2%、66.0%、40.1%。单因素分析结果显示,肿瘤大小、恶性程度与患者术后的无病生存率和疾病特异性生存率显著相关(P<0.05),且复发后是否多次手术与患者术后的疾病特异性生存率显著相关(P<0.05)。Cox回归分析结果显示,肿瘤大小、恶性程度是影响患者术后无病生存率的独立危险因素(P<0.05);肿瘤大小、恶性程度、复发后是否多次手术是影响患者术后疾病特异性生存率的独立危险因素(P<0.05)。结论肿瘤大小、恶性程度和复发后是否多次手术是原发性肠系膜肉瘤患者预后的独立危险因素,因此,临床上应重视对原发性肠系膜肉瘤患者的早期筛查与诊断,减轻患者术前肿瘤恶性程度,对术后复发患者应考虑多次手术治疗,从而提高患者术后总生存期。

Objective To analyze the survival prognosis of patients with primary mesenteric sarcoma treated by surgery and its influencing factors.Method Clinical data and follow-up data of 147 patients with primary mesenteric sarcoma admitted to Linyi Cancer Hospital from January 2004 to December 2017 were retrospectively analyzed.The clinicopathological characteristics and postoperative follow-up were recorded.Disease free survival rate and disease specific survival rate were evaluated,and the prognostic factors were analyzed.Result Among the 147 patients,106 patients had tumor size of 10cm or above,116 patients were highly malignant,most of the first symptom of the disease was abdominal mass,and 113 patients had postoperative recurrence.The postoperative follow-up time of the patients ranged from 10 to 130 months,with a median follow-up time of 58.0 months.There were 131 cases of recurrence and metastasis and 131 cases of death,all of which died due to multiple organ failure caused by extensive abdominal metastasis.The disease free survival rate of patients at 1 year,3 year and 5 year after surgery were 85.0%,59.9%and 23.1%.Disease specific survival rate at 1 year,3 year and 5 year were 93.2%,66.0%and 40.1%.Univariate analysis results showed that tumor size and malignancy were significantly correlated with postoperative disease free survival rate and disease specific survival rate(P<0.05),and multiple operations after recurrence were significantly correlated with postoperative disease specific survival rate(P<0.05).Cox regression analysis showed that tumor size and degree of malignancy were independent risk factors for postoperative disease free survival rate(P<0.05),while tumor size,degree of malignancy and whether multiple operations after recurrence were independent risk factors for postoperative disease specific survival rate(P<0.05).Conclusion Tumor size,malignant degree and whether multiple operations are independent risk factors for the prognosis of patients with primary mesenteric sarcoma,therefore,clinical should attach importance to early screening and diagnosis of it,relieve patients with tumor malignant degree,and should consider multiple surgical treatments after recurrence of surgical treatment,so as to improve patients’overall survival after surgery.