38例腹膜后脂肪肉瘤的临床分析

Clinical analysis of 38 retroperitoneal liposarcoma

目的 分析腹膜后脂肪肉瘤的治疗结果。方法 1958～1998年我院收治38例腹膜后脂肪肉瘤。21例为首程治疗,17例局部复发后再程治疗。21例初治患者均接受手术治疗,手术完整切除率为86％。3例接受术后放射治疗。17例外院术后复发再程治疗患者有13例在我院接受手术,4例接受单纯放疗。再程手术完整切除率为54％,1例接受术后放放射治疗。放疗剂量DT30Gy～70Gy,中位剂量50Gy。结果 全组患者5年总生存率为50％,5年远转率为7.3％,5年局部复发率为65％,初程治疗和再程治疗组的5年总生存率为53％和48％,无显著性差异(P=0.293,5年局部复发率为59％和74％,无显著差别(P=0.615)。全组手术完整切除组5年生存率为58％,部分切除或未切除者5年生存率为27％,有显著性差异(P=0.006)。34例有肿瘤大小记录的患者,其中4例肿瘤<10cm,均存活;22例肿瘤10～30cm,有13例死亡;8例肿瘤≥30cm,有6例死亡。结论 腹膜后脂肪肉瘤的治疗以手术为主,手术完整切除可显著提高生存率。经积极治疗,复发患者仍能取得很好的效果。

Objective To assess the outcome of patients with retroperitoneal liposarcoma. Methods From 1958 to 1998, 21 previously untreated and 17 recurrent patients with retroperitoneal liposarcoma were reviewed. All 21 previously untreated patients received surgery at our institution. Of these, 16 (86%) patients had a gross complete resection, postoperative radiotherapy was given to 3 patients. For the 17 recurrent patients, 13 received surgery, 4 radio- therapy alone. Of 13 patients treated with surgery, 7 (54%) had a gross complete resection, postoperative radiotherapy was given to 1 patients. The irradiation dose ranged from 30 to 70Gy, with a median of 50Gy. Results The 5-year ac- tuarial overall survival (OS) for all patients was 50%. It was 53 % and 48 % for previously untreated and recurrent patients. The 5-year local recurrence rate was 65 % for all patients. It was 59% and 74% for previously untreated and recurrent patients. The 5 - year OS was 58 % and 27% for patients with gross complete resection and macroscopic resid- ual or biopsy, with improved survival for gross complete resection as compared with macroscopic residual or biopsy (P= 0.006). There was a trend of increasing death rate with large tumor size. Of the 4 patients with tumor<10cm, none died, 22 with tumor 10- 30cm , 13 died, 8 with tumor≥30cm, 6died. Conclusions Surgery remains the curative treatment modality in patients with retroperitoneal soft tissue sarcoma, with complete resection affording the best survival.