脂肪肉瘤患者预后的影响因素分析  

Evaluation of prognostic factors for liposarcoma

作　　者：张琦[1] 李菊明[1] 刘金龙[2] 韦永中[1] Zhang Qi;Li Juming;Liu Jinlong;Wei Yongzhong(Department of Orthopedics,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,210029 [2]南京医科大学第一附属医院普外科,210029

出　　处：《中华肿瘤杂志》2019年第12期943-948,共6页Chinese Journal of Oncology

摘　　要：目的探讨脂肪肉瘤患者的预后影响因素。方法回顾性分析南京医科大学第一附属医院2009年7月至2017年3月收治且获得随访的78例脂肪肉瘤患者资料,其中男41例,女37例;年龄18~85岁,中位年龄60.5岁。高分化脂肪肉瘤27例,黏液性脂肪肉瘤13例,去分化脂肪肉瘤35例,多形性脂肪肉瘤3例;四肢脂肪肉瘤40例,腹膜后脂肪肉瘤38例。行扩大切除21例,行边缘切除57例。术后放疗7例,化疗9例。以无进展生存时间和总生存时间作为预后评价标准,采用单因素和多因素分析评价影响脂肪肉瘤患者预后的因素。结果复发43例,其中四肢脂肪肉瘤9例,腹膜后脂肪肉瘤34例;转移18例,其中四肢脂肪肉瘤4例,腹膜后脂肪肉瘤14例。患者的5年无进展生存率为31.4%,5年生存率为44.3%。单因素分析结果显示,肿瘤的病理分型和肿瘤部位与患者的中位无进展生存时间有关(均P<0.05),肿瘤的病理分型、肿瘤部位、肿瘤大小、术后复发和转移情况与患者的中位总生存时间有关(均P<0.05)。多因素分析结果显示,发病部位是影响脂肪肉瘤患者无进展生存的独立因素,病理分型和转移情况是影响脂肪肉瘤患者总生存的独立因素(均P<0.05)。接受放疗的黏液性脂肪肉瘤患者的中位无进展生存时间为34.6个月,明显长于未放疗的黏液性脂肪肉瘤患者(28.3个月,P<0.05)。结论发病部位是影响脂肪肉瘤患者无进展生存的独立因素,腹膜后脂肪肉瘤更易出现复发或转移。脂肪肉瘤患者的总生存时间受病理分型和转移情况的影响。放疗可延长黏液性脂肪肉瘤患者的无病生存时间。Objective To investigate the relevant prognostic factors of liposarcoma(LPS).Methods The data of 78 patients with LPS treated in our hospital from July 2009 to March 2017 were reviewed.The 78 patients included 41 males and 37 females,and the average age was(60.5±13.4)years(ranged from 18 to 85 years).Among the 78 LPS patients,27 were well-differentiated LPS,13 were myxoid LPS,35 were dedifferentiated LPS and 3 were pleomorphic LPS.The distribution of lesion location included 40 cases of extremities and 38 cases of retroperitoneal.21 cases were treated with radical excision,57 cases were treated with marginal resection.7 patients were treated with postoperative radiotherapy and 9 patients with postoperative chemotherapy.Progression free survival(PFS)and overall survival(OS)of LPS patients were analyzed as clinical outcomes.Prognostic factors were analyzed by univariate and multivariate analyses.Results 43 patients had local recurrence(9 of extremities/34 of retroperitoneal),18 patients with metastasis(4 of extremities/14 of retroperitoneal).The 5-year PFS rate was 31.4%and 5-year OS rate was 44.3%.Univariate analysis showed that the histological subtype and the tumor location were related with PFS(P<0.05),while the histological subtype,the tumor location,the tumor size,the recurrence and metastasis were related with OS(P<0.05).Multivariate cox regression analysis showed that the tumor location was the independent prognostic factor of PFS(P<0.05),while the histological subtype and metastasis were the independent prognostic factors of OS(P<0.05).The median PFS of patients with myxoid LPS treated with radiotherapy was 34.6 months,which was significantly longer than 28.3 months of myxoid LPS patients without radiotherapy(P<0.05).Conclusions The tumor location is an independent prognostic factor of PFS in LPS patients.Retroperitoneal LPS is more prone to relapse and metastasize.OS is affected by pathological subtype and metastasis.Radiotherapy can improve the PFS of patients with myxoid LPS.

关 键 词：脂肪肉瘤 外科手术 治疗效果 预后 

分 类 号：R73[医药卫生—肿瘤]