Soft Tissue Sarcomas of Head and Neck: A Univariate and Multivariate Analysis

頭頸部軟組織肉瘤－預後因子之單變量及多變量分析

王茂山(Mao-Shan Wang) ； 林進德(Jin-Teh Lin) ； 黃志宏(Chih-Hung Hwang) ； 馬旭(Shi Ma) ； 葉發來(Fa-Lai Yeh) ； 方榮煌(Rong-Hwang Feng)

《中華民國重建整形外科醫學會雜誌》 6卷3期 (1997/09) Pp. 164-175

https://doi.org/10.7096/JPRSA.199709.0164

摘要

頭頸部之肉瘤很少發生，軟組織肉瘤更少，約佔所有頭頸部惡性腫瘤之1%以下。文獻上對頭頸部軟組織肉瘤很少著墨，對其預後因子之探討資料也寥寥無幾。本論文運用統計學之方法，以單變量多變量分析來研究其預後因子及其中的相關性。
本論文根據臺北榮總重建整形外科治療頭頸部軟組織肉瘤之經驗，迴溯研究自1976至1996所有資料，總計頭部軟組織肉瘤有36個病例，刪除資料不全1例，無法追蹤3例，本研究報告僅有32例，其中男性20例，女性12例。發病年齡6歲至88歲，平均43歲。
運用臨床方法及統計方法SAS程式之步驟法(SAS program stepwise method)、單變量及多變量Cox's危險比例模式(proportional hazards models)，多研究其預後因子。
臨床因子之單變量分析包括：發病年齡、性別、症狀出現至診斷治療時間、有無化學治療、有無放射線治療、腫瘤病理診斷、腫瘤位置、有無復發或轉移、腫瘤大小，其中有無化學治療及腫瘤大小對其存活影響具有意義。最常見的腫瘤位置是頸部(40.6%)、其次是頭皮(25.0%)、臉(12.5%)。最多的肉瘤是纖維肉瘤(24.2%)、其次是惡性纖維組織細胞肉瘤(21.2%)。最常見的腫瘤轉移位置是肺。
以多變量分析來研究發現，有無復發或轉移和腫瘤大小兩項均爲獨立變數，且對其存活影響是有意義的。以Kaplan-Meier方法分析，本研究概括存活率爲2年74.92%，5年66.10%，10年56.27%。

並列摘要

Soft tissue sarcomas are rare malignancies in head and neck region. Data for prognostic factors are limited, prompting this study with statistical methodology.
This report is based on the experience of management of 36 cases of soft tissue sarcomas of head and neck, seen at the Veterans General Hospital-Taipei between the years 1976 and 1996. Inadequate data and loss of follow-up cases were excluded. Only 32 cases were available. The study involved 20 males and 12 females, ages 6-88 (median 43) years.
Clinical and statistical analyses were introduced. The prognostic factors were evaluated by univariate and multivariate Cox's proportional hazards models, using the SAS program with stepwise method.
Univariate analysis of clinical factors including age, sex, interval between onset of symptoms and diagnosis, adjuvant chemotherapy, adjuvant radiotherapy, pathology of the tumor, primary site, recurrence or metastasis and tumor size showed that chemotherapy and tumor size were significant for survival. Patients treated without chemotherapy had a better prognosis than those treated by other methods (p0.058). The latter showed a 2-year survival of 80% versus 58% and a 5-year survival of 69% versus 39% for the former. Patients with tumors measuring 5 cm or less showed a better prognosis than those with tumors larger than 5 cm (p=0.065). The former showed a 2-year survival of 83% versus 54% and a 5-year survival of 73% versus 36% for the latter. The most common anatomic location was the neck (40.6%), followed by the scalp (25.0%) and the face (12.5%). Fibrosarcoma was the most common histologic type (24.2%), followed by malignant fibrous histiocytoma (21.2%). Lung was the most common site of distant metastasis. With multivariate analysis, both size and metastases were independent factors and statistically significant for survival (p=0.0004 for size and p=0.0177 for metastases). The 2-year survival rate in patients with tumor size 5 cm or less and no local recurrence or metastasis was 94%, tumor size＞5 cm without local recurrence or metastasis and tumor size 5 cm or less with local recurrence was 83%, and the other patients was 54%, respectively.
The overall survival rate was 74.92% at 2 years, 66.10% at 5 years, and 56.27% at 10 years.

並列關鍵字

soft tissue sarcoma ； head and neck ； univariate ； multivariate analysis