大腿软组织恶性肿瘤切除术后复发的危险因素及功能评价  

Risk factors and functional evaluation of recurrence after resection of thigh soft tissue malignant tumor

作　　者：曲昊 王柯懿 石玮 牟皓晨 吴佳丹 谢君燕 王聪 李恒元[1] 李秀茅 林鹏[1] 严晓波[1] 柳萌[1] 黄鑫[1] 林秾[1] 叶招明[1] Qu Hao;Wang Keyi;Shi Wei;Mou Haochen;Wu Jiadan;Xie Junyan;Wang Cong;Li Hengyuan;Li Xiumao;Lin Peng;Yan Xiaobo;Liu Meng;Huang Xin;Lin Cong;Ye Zhaoming(Department of Orthopaedics,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2023年第12期841-848,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金项目(82101649)。

摘　　要：目的探讨大腿软组织恶性肿瘤切除术后复发的危险因素及患者术后下肢功能评价。方法回顾并分析2011年5月至2021年5月于浙江大学医学院附属第二医院骨科行大腿软组织恶性肿瘤切除术患者211例,男117例、女94例,年龄53(43,65)岁。非典型或高分化脂肪肉瘤59例、其他类型脂肪肉瘤30例、恶性纤维组织细胞瘤33例、纤维肉瘤19例、横纹肌肉瘤12例、平滑肌肉瘤12例、滑膜肉瘤9例、其他37例。记录患者肌肉、骨或血管神经组织肿瘤受累情况,肌间室受累情况,术后国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS)功能评分,复发情况。对解剖结构与术后复发的关系采用Cox逻辑回归分析,确定危险因素;比较不同的肌间室分组(内侧肌间室,前侧肌间室,后侧肌间室)的累计复发率;采用箱形图比较切除不同解剖结构(如股外侧肌、股二头肌、股骨等)的患者术后的功能情况。结果211例中累计复发40例,复发率为18.9%;复发时间为术后37.0(18.2,52.8)个月。三个独立危险因素与复发相关:病理学分级[HR=3.86,95%CI(1.75,8.51)]、累及股中间肌[HR=3.05,95%CI(1.53,6.06)]和累及股内肌[HR=3.17,95%CI(1.56,6.41)]。前间室内肿瘤切除患者五年累计复发风险率为(23.8%)较未切除者(10.3%)更高,差异有统计学意义(P=0.020);内侧间室内肿瘤切除患者累计复发风险率与未切除患者的差异无统计学意义(P=0.783);后间室内肿瘤切除患者五年累计复发风险率为4.8%,较未切除者(22.6%)更低,差异有统计学意义(P=0.002)。末次随访时术后MSTS评分(26.0±3.2)分(范围9~30分)。切除部分股骨、股中间肌、股内侧肌及股直肌切除后患者功能较差,MSTS评分分别为25(23,28)、26(24,28)、26(24,28)、26(24,27)分。结论大腿软组织恶性肿瘤切除术后局部复发的危险因素包括与肿瘤的病理学分级、是否累及股中间肌或股内侧肌,前间室内肿瘤术后复发率更高;若肿瘤累�Objective To explore the risk factors of recurrence after resection of thigh soft tissue malignant tumors and the evaluation of the postoperative lower limb function.Methods A total of 211 patients who underwent thigh soft tissue malignant tumor resection in the Department of Orthopaedics of the second affiliated Hospital of Medical College of Zhejiang University from May 2011 to May 2021 were retrospectively analyzed,including 117 males and 94 females,aged 53(43,65)years.There were 59 cases of atypical/well-differentiated liposarcoma,30 cases of other types of liposarcoma,33 cases of malignant fibrous histiocytoma,19 cases of fibrosarcoma,12 cases of rhabdomyosarcoma,12 cases of leiomyosarcoma,9 cases of synovial sarcoma,and 37 cases of others.The tumor involvement of muscle,bone,blood vessel,nerve tissue and intermuscular compartment,postoperative Musculoskeletal Tumor Society(MSTS)functional score and recurrence were recorded.The relationship between anatomical structure and postoperative recurrence was analyzed by Cox logistic regression to determine risk factors;the cumulative recurrence rate of different compartment groups(medial compartment,anterior compartment,and posterior compartment)were compared;The Box plot was used to compare the postoperative function of patients with resection of different anatomical structures(e.g.,vastus lateralis,biceps femoris,femur,etc.).Results A total of 34 out of 211 patients relapsed,with a recurrence rate of 16.1%.The recurrence time ranged from 2.6 months to 91.6 months after operation,with a median recurrence time of 37.0(18.2,52.8)months.Three independent risk factors were found to be associated with recurrence,namely:pathological grade[HR=3.86,95%CI(1.75,8.51)],involvement of vastus intermedius[HR=3.05,95%CI(1.53,6.06)],and involvement of vastus medialis[HR=3.17,95%CI(1.56,6.41)].The recurrence rate of patients with anterior chamber tumor resection was 35.3%,which was higher than that of patients without tumor resection(16.2%),and the difference was statistically sig

关 键 词：软组织肿瘤 四肢 复发 危险因素 

分 类 号：R738.6[医药卫生—肿瘤]