四肢与躯干侵袭性纤维瘤病的治疗与预后影响因素分析  

An analysis of the treatment and prognostic factors of desmoid tumors of the extremities and trunk

作　　者：张鑫鑫[1] 徐立斌[1] 赵振国[1] 刘婷[1] 袁振南[1] 于胜吉[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所骨科,北京100021

出　　处：《中国骨与关节杂志》2015年第1期26-30,共5页Chinese Journal of Bone and Joint

摘　　要：目的：分析四肢与躯干侵袭性纤维瘤病的临床特征与预后的影响因素，为临床治疗及预后评价提供依据。方法对1999年1月至2014年9月，我院收治并获随访的72例四肢或躯干侵袭性纤维瘤病患者进行回顾性分析，总结其临床特点、治疗方式，记录术后复发等相关数据。以患者性别、年龄、肿瘤部位、肿瘤大小、切缘情况、肿瘤为初发或复发、有无放疗、有无化疗为因素，进行影响复发的相关因素分析。结果本组无死亡病例，5年总生存率为100%。72例均获随访，随访时间为2～184个月，中位时间为96个月。2年复发率为13.9%，5年复发率为20.8%。单因素分析，影响2年复发率的因素为切缘情况、有无放疗，其中，R1切除与R0切除相比、未接受放疗与接受术中或术后放疗相比，前者的2年复发率均高于后者（ P＜0.05）；影响5年复发率的因素为肿瘤发生部位、肿瘤大小、切缘情况、有无放疗，其中肿瘤＞5 cm与≤5 cm相比、发生于四肢与发生于躯干相比、R1切除与R0切除相比、未接受放疗与接受术中或术后放疗相比，前者的5年复发率均显著高于后者（ P＜0.05）。多因素分析发现，肿瘤大小为独立的复发危险因素（ RR＝5.541，P＝0.040）。结论四肢与躯干侵袭性纤维瘤的复发与肿瘤大小、肿瘤部位、切缘情况及有无放疗具有相关性，肿瘤大小为其独立的复发危险因素。为了减少复发，手术切除瘤体时，应尽可能达到R0切除；对于发生于四肢和（或）肿瘤最大径＞5 cm的侵袭性纤维瘤病，应建议其放疗，以获得更好的预后；在此基础上，如果手术切缘为阳性，辅助放疗的适应证则更为明确。Objective To analyze the clinical characteristics and prognostic factors of desmoid tumors of the extremities and trunk, and to provide the basis for clinical treatment and prognostic evaluation.Methods Clinical data of 72 patients with desmoid tumors of the extremities and trunk who were adopted and followed up from January 1999 to September 2014 were retrospectively reviewed. The clinical characteristics, treatment approaches, postoperative recurrence and other related data were summarized. The factors related to recurrence were recorded, including gender, age, tumor site, tumor size, surgical margin, primary or recurrent tumor, radiotherapy and chemotherapy.Results No death occurred, and the 5-year overall survival rate was 100%. All the 72 patients were followed up from 2 to 184 months, and the median follow-up time was 96 months. The 2-year recurrence rate was 13.9%, and the 5-year recurrence rate was 20.8%. Prognostic factors associated to the 2-year recurrence rate included surgical margin and with or without radiotherapy. The 2-year recurrence rate after R1 resection was higher than that after R0 resection （P〈0.05 ）. The 2-year recurrence rate in the patients who did not receive radiotherapy was higher than that in the patients who received radiotherapy during and after the surgery （P〈0.05 ）. Prognostic factors associated to the 5-year recurrence rate factors included tumor site, tumor size, surgical margin and with or without radiotherapy. The 5-year recurrence rate with the tumor size more than 5 cm was obviously higher than that with the tumor size less than or equal to 5cm （P〈0.05 ）. The 5-year recurrence rate in the patients with desmoid tumors of the extremities was obviously higher than that in the patients with desmoid tumors of the trunk （P＆lt;0.05 ）. The 5-year recurrence rate after R1 resection was obviously higher than that after R0 resection （P〈0.05 ）. The 5-year recurrence rate in the patients who did not receive radiotherapy was obviously higher than that in th

关 键 词：纤维瘤病 侵袭型 治疗 预后 影响因素分析 肿瘤复发 局部 

分 类 号：R738[医药卫生—肿瘤]