经动脉新辅助化疗治疗软组织恶性纤维组织细胞瘤的临床疗效及预后因素研究  

A study of clinical effects and prognosis factors on transarterial neoadjuvant chemotherapy of malignant fibrous histiocytoma in soft tissues

作　　者：郭钧 李鼎锋 刘蜀彬 崔秋 刘铖 

机构地区：[1]解放军307医院骨科,北京100071

出　　处：《中国骨与关节杂志》2015年第5期348-353,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨经动脉新辅助化疗治疗软组织恶性纤维组织细胞瘤（malignant fibrous histiocytoma,MFH）的疗效,并分析软组织MFH预后相关因素。方法回顾性分析1999年9月至2011年12月,我院收治的101例软组织MFH患者的临床资料。所有病例均经化疗泵动脉给予顺铂、阿霉素、去甲斑蝥素化疗。根据患者就诊时是否进行过治疗的情况分原发肿瘤组和复发肿瘤组两组,分别为44例（A组）和57例（B组）,每组再根据治疗方式为新辅助化疗结合手术或单纯新辅助化疗各细分为2组。A组中手术切除的15例,为A1组;未行手术治疗的29例,为A2组。B组中行肿瘤手术的45例,为B1组;未行手术的12例,为B2组。采用肿瘤坏死率来判断手术患者化疗的疗效。观察5年总体生存率、5年无瘤生存率、复发及转移情况,并对患者年龄、性别、肿瘤大小、肿瘤部位、肿瘤浸润组织深度、肿瘤是否复发、病理类型、组织学分级及化疗后组织反应等9项影响预后的因素进行统计学分析。结果本组101例随访3～145个月,平均60个月。（1）本研究共23例肿瘤切除标本进行了肿瘤坏死率分析,A1组5例肿瘤切除标本中肿瘤坏死率75.0%,4例（80.0%）化疗反应好,B1组18例肿瘤坏死率73.8%,14例（77.8%）化疗反应好,两组肿瘤坏死率及化疗反应好者比率相比,差异无统计学意义（P〉0.05）。（2）本组总体生存率65.3%,原发组5年无瘤生存率和总体生存率分别为70.5%和75.0%,复发组5年无瘤生存率和总体生存率分别为56.1%和57.9%,两组的总体生存率相比,差异有统计学意义（P〈0.05）。（3）单独局部复发者共18例（17.8%）,其中A组7例（15.9%）,B组11例（19.3%）,平均复发时间14个月;单独远处转移共5例（5.0%）,A组1例（2.3%）,B组4例（7.0%）,平均转移发生时间1年（2～50个月）;局部复发伴远处转移者共15例（14.9%）。（4）患者年龄（P=0.03）、肿瘤大小（P=Objective To explore clinical effects in transarterial neoadjuvant chemotherapy of malignant fibrous histiocytoma （ MFH ） in soft tissues, and to analyze the factors related to the prognosis of MFH in soft tissues. Methods From September 1999 to December 2011, clinical documents of 101 MFH in soft tissues patients treated by transarterial administration of Cisplatin （ CDDP ）, Adriamycin （ AMD ） and Norcantharidin （ NTCD ） were reviewed. All the patients were divided into primary group （ group A, 44 cases ） and recurrent group （ group B, 57 cases ） and each group was further divided into 2 groups by treatment methods. Fifteen patients （ group A1 ） in group A received surgical resection, and the other 29 patients （ group A2 ） received simple transarterial neoadjuvant chemotherapy. Forty- five patients （ group B1 ） in group B received surgical resection and the other 12 patients （ group B2 ） received simple transarterial neoadjuvant chemotherapy. For patients in the operation groups, chemotherapy effects were determined from the tumor necrosis rate in the resected specimen. The 5-year relapse-free survival rate, the overall survival rate, recurrence and metastasis were observed. Nine factors that might affect prognosis such as age, sex, tumor size, tumor site, tumor infiltration depth, recurrence occurrence, pathological type, histological grade and histological response of chemotherapy were analyzed statistically. Results One hundred and one cases received follow-up. The average follow- up period was 60 months （ range： 3-145 months ）. （ 1 ） Twenty-three resected specimens were analyzed by tumor necrosis rate. 4 / 5 cases （ 80.0% ） in group A1 showed good chemotherapy response and the average tumor necrosis rate was 75.0%; 14 / 18 cases （ 77.8% ） in group B1 showed good chemotherapy response and the average tumor necrosis rate was 73.8%; The differences between the two groups were not significant. （ P〉0.05 ）. （ 2 ） The 5-year relapse-free survival r

关 键 词：软组织肿瘤 放化疗 组织细胞瘤 恶性纤维 预后 

分 类 号：R730.262[医药卫生—肿瘤]