肢体软组织肉瘤术后辅助治疗105例预后分析  

Prognostic analysis of adjuvant treatment for 105 patients with extremity/trunk soft tissue sarcomas

作　　者：张路[1] 樊征夫[1] 方志伟[1] 刘佳勇[1] 白楚杰[1] 薛瑞峰[1] 李舒[1] 高天[1] ZHANG Lu;FAN Zheng fu;FANG Zhi-wei;LIU Jia-yong;BAI Chu-jie;XUE Rui feng;LI Shu;GAO Tian(Department of Orthopaedic Oncology, Peking University Cancer Hospital ＆ Institute, Key laboratory of Carcinogenesis and Translational Research （Ministry of Education ）, Beijing 100142, P. R. China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所骨与软组织肿瘤科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华肿瘤防治杂志》2018年第8期566-571,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的肢体软组织肉瘤(extremity/trunk soft tissue sarcoma,ESTS)需要规范化综合治疗,但目前ESTS术后辅助治疗方式选择尚有争议。本研究通过分析长期随访结果,探讨不同辅助治疗方式对Ⅱ、Ⅲ期(AJCC分期)ESTS患者预后的影响。方法回顾性分析2007-07-01-2012-12-31北京大学肿瘤医院骨与软组织肿瘤科收治经过广泛切除手术的105例Ⅱ、Ⅲ期(AJCC分期)ESTS患者。采用Kaplan-Meier法评估5年总生存率(overall survival rate,OS),Log-rank法检验和单因素分析,Cox多因素回归分析独立预后因素。结果105例患者均得到随访,中位随访时间为59个月(5~115个月),其中复发26例(24.8%),远处转移46例(43.8%),转移部位为肺、骨骼和淋巴结,死亡29例(27.6%)。化疗组74例(70.5%),未化疗组31例(29.5%),5年OS分别为70.0%和57.0%,差异无统计学意义,P=0.073。放疗组71例(67.6%),未放疗组34例(32.4%),5年OS分别为74.0%和47.0%,差异无统计学意义,P=0.216。联合放、化疗组54例(51.4%),未联合放、化疗组51例(48.6%),5年OS分别为75.0%和59.0%,差异有统计学意义,P=0.023。单因素分析显示,肿瘤大小、组织学分级(FNCLCC)及联合放、化疗与预后相关,均P值<0.05。患者的年龄、性别、肿瘤部位、复发性肿瘤、组织学亚型、AJCC分期、单纯化疗、单纯放疗与5年OS无关,均P值>0.05。Cox回归分析显示,肿瘤大小和组织学分级(FNCLCC)是影响ESTS患者5年OS的独立预后因素,均P值<0.05。联合放、化疗对5年OS无显著影响,P>0.05。肿瘤最大径≤5cm的患者更易接受联合放、化疗。性别、肿瘤部位、入院情况、组织学亚型、组织学分级(FNCLCC)、AJCC分期不是影响选择联合放、化疗的因素。结论对于Ⅱ、Ⅲ期ESTS患者,肿瘤的大小和组织学分级是影响5年OS的独立因素,广泛切除手术联合放、化疗可能有益于提高患者的5年OS。肿瘤最大径≤5cm的患者更易接受联合放、化疗。OBJECTIVE Extremity/trunk soft tissue sarcomas（ESTS） need standardized and comprehensive treatment. However,the choice of adjuvant therapy after ESTS remains controversial. The study aimed to investigate the prog-nosis and prognostic factors of patients with stage Ⅱ and Ⅲ （AJCC stage） ESTS with different adjuvant therapy by long- term follow-up results. METHODS From June 1,2007 to December 31,2012,105 ESTS patients after wide excision were enrolled in Peking University Cancer Hospital Department of Orthopaedic Oncology. Kaplan-Meier method was used to e- valuate the 5 years survival rate（5-year OS） ,and Cox model was used for multivariate facotor analysis. RESULTS Totally 105 patients were followed up, the median follow-up time was 59 months （5- 115 months）, including 26 cases of recur- rence（24.8%）, 46 cases（43.8%） of distant metastasis（metastasis to the lung, bone and lymph nodes）, 29 cases of death （27.6%）. There were 74 cases（70. 5%） in chemotherapy group and 31 cases（29.5%） in no-chemotherapy group. The 5 year survival rates were 70.0 % and 57.0 %, respectively,and the difference was not statistically significant（P= 0. 073）. There were 71 cases（67.6 %） in radiotherapy group and 34 cases（32.4%） in no-radiotherapy group, the 5 year survival rates were 74.0% and 47.0%, respectively, and the difference was not statistically significant（P= 0.216）. There were 54 cases（51.4%） in the combined radiotherapy and chemotherapy group,51 cases（48.6%） in the no-combined radiother- apy and chemotherapy group,and the 5 year survival rates were 75.0% and 59.0% respectively, and the difference was statistically significant（P= 0. 023）. Univariate analysis showed that tumor size, histological grade（FNCLCC） and combined radiotherapy and chemotherapy were associated with 5-year OS, P（0.05. Patient＇s age, sex, tumor location, recurrent tumor,histological subtype, AJCC stage, chemotherapy and radiotherapy were not significantly related with 5-year OS,P〉

关 键 词：肢体软组织肉瘤 辅助治疗 预后因素 AJCC分期 

分 类 号：R738.6[医药卫生—肿瘤]