手术切除联合术中放疗治疗四肢复发性软组织肉瘤的安全性及近期疗效

Safety and short-term efficacy of surgical resection combined with intraoperative radiotherapy in the treatment of recurrent soft tissue sarcoma of the extremities

目的:探讨手术切除联合术中放疗治疗四肢复发性软组织肉瘤的安全性及近期疗效。方法:收集2012年1月至2018年6月于我院诊断为四肢复发性软组织肉瘤并行手术切除的患者,共93例,根据患者放疗方案分为术中放疗组(38例)和体外放疗组(55例)。采用Log-rank单因素和Cox比例风险模型分析患者局部无复发生存期和总生存期的独立危险因素,并对两组术后并发症、急慢性放射性损伤、肢体功能等指标进行对比。结果:复发性软组织肉瘤局部无复发生存时间和总体生存时间与AJCC分期(P=0.030和P=0.012)和FNCLCC分级(P=0.024和P=0.008)有关,术中放疗组与体外放疗组局部无复发生存期和总体生存时间没有明显统计学差异(P=0.663和P=0.691)。FNCLCC分级显著影响局部无复发生存期(HR=2.461,95%CI 1.094~5.537,P=0.029)和总生存期(HR=2.731,95%CI 1.249~5.971,P=0.012)。两组术后Clavien-Dindo并发症分级(P=0.048)、急性放射性损伤(P=0.043)、慢性放射性损伤(P<0.001)以及肢体功能评分(P<0.001)差异均有统计学意义。结论:手术切除联合术中放疗治疗四肢复发性软组织肉瘤具有较好的近期疗效及安全性。

Objective:To investigate the safety and short-term efficacy of surgical resection combined with intraoperative radiotherapy in the treatment of recurrent soft tissue sarcoma of the extremities.Methods:93 patients with recurrent soft tissue sarcoma of limbs diagnosed in our hospital from January 2012 to June 2018 were collected.According to the radiotherapy regimen, they were divided into intraoperative radiotherapy group(38 cases) and extracorporeal radiotherapy group(55 cases).Log rank univariate and Cox proportional hazards models were used to analyze the independent risk factors of local recurrence free survival and overall survival, and the postoperative complications, acute and chronic radiation injury, limb function and other indicators were compared between the two groups.Results:Local recurrence free survival and overall survival were associated with AJCC stage(P=0.030 and P=0.012) and FNCLCC grade(P=0.024 and P=0.008).There was no significant difference in local recurrence free survival and overall survival between the two groups(P=0.663 and P=0.691).FNCLCC grade significantly affected local recurrence free survival(HR=2.461,95%CI 1.094~5.537,P=0.029) and overall survival(HR=2.731,95%CI 1.249~5.971,P=0.012).There were significant differences in Clavien Dindo complication grade(P=0.048),acute radiation injury(P=0.043),chronic radiation injury(P<0.001) and limb function score(P<0.001) between the two groups.Conclusion:Surgical resection combined with intraoperative radiotherapy in the treatment of recurrent soft tissue sarcoma of the extremities has good short-term efficacy and safety.