Treatment of Soft Tissue Sarcoma in Extremities-10-Year Clinical Experience in Taipei Veterans General Hospital

肢體惡性軟組織肉瘤之治療－台北榮民總醫院10年經驗及臨床分析

陳正豐(Cheng-Fong Chen) ； 陳威明(Wei-Ming Chen) ； 黃清貴(Ching-Kuei Huang) ； 陳天雄(Tain-Hsiung Chen)

《Journal of Orthopaedic Surgery Taiwan》 23卷3期 (2006/09) Pp. 83-90

並列摘要

Soft tissue sarcomas (STS) are a rare and heterogeneous group of musculoskeletal tumors originated from connective tissue; they account for less than 1% of all malignancies. Due to the rarity and diversity of STS, it is difficult to amass a sufficient number of patients to allow for evaluation of treatments and prognostic factors.
From January 1992 to March 2003, 177 patients with STS in their extremities were treated at the authors' institute. There were 108 males and 69 females with an average age of 53.1 years at diagnosis. Predominant histologic subtypes included liposarcoma (47), malignant fibrous histiocytoma (35), leiomyosarcoma (17), synovial sarcoma (14) and alveolar soft-part sarcoma (10). Staging followed AJCC classification and there were 12 cases of ⅠA, 15 IB, 41 ⅡA, 18 ⅡB, 70 Ⅲ and 15 Ⅳ. There were 26 (14.7%) unplanned surgeries at other institutes before referral. Patients had undergone wide excision (119), re-margin wide excision (23), marginal excision (32) and amputation with wide margin (3). The procedures were performed after diagnosis confirmed by pathologic examination and the adjuvant chemotherapy or radiotherapy were applied in selected cases with highgrade tumors or without adequate surgical margin.
The mean follow-up time was 65.2 months. The average tumor size was 13.6 cm in greatest dimension. 41 patients (23.2%, 20.6% in low-grade and 24.8% in high-grade) had local recurrence at 20.2 months from prior surgery, including margin excision in 27 patients (27/32, 84.4%), re-margin wide excision in 9 (9/23, 39.1%) and wide excision in 5 (5/119, 4.2%). 53 patients (29.9%, 11.8% in low-grade and 41.3% in high-grade) developed distant metastasis at mean 32.3 months from diagnosis and 32 patients who received metastasectomy had a superior 5-year survival rate, compared with the remaining 21 patients without metastasectomy (59.4% vs. 19.0%, P=0.0083). Concerning survival status, 43 patients died of the disease (24.2%), 8 died of another disease (4.5%), 30 remained alive with continuing disease (16.9%), and 104 remained alive and were disease-free (58.7%). The overall survival rate was 78.3% at 2 years, 64.1% at 5 years and 47.4% at 10 years. Compared with the planned surgery, the unplanned surgery had higher local recurrence (34.6% vs. 21.2%, P=0.094) and amputation rate (15.4% vs 8.6%, P=0.083).
High-grade tumor and inadequate initial excision were defined as poor prognostic factors for local recurrence and distant metastasis with relatively higher mortality rate. In addition, unplanned surgery unfavorably impacted local recurrence and amputation rate, compared with planned surgery. Referral to a sarcoma center before unplanned surgery or hasty biopsy was strongly recommended to decrease the amputation and local recurrence rate. Concerning the patients with distal metastasis, those who underwent metastasectomy had a 5-year survival rate that was three times higher than those who did not undergo surgery. If patients can tolerate the surgery after evaluation, metastasectomy should be performed aggressively.

並列關鍵字

soft tissue sarcoma ； extremity ； unplanned surgery ； metastasectomy