The Prognostic Significance of Adequate Surgical Margin for Head and Neck Sarcomas: A Retrospective Study of Thirty-one Cases

本次報告的目的在分析台中榮民總醫院口腔顎面外科自1982年至2007年間對頭頸部肉瘤(Sarcoma)病患治療之結果分析。藉由回溯患者之病歷及組織病理檢查結果，共確認三十一位患者，包括十七位男性(54.8%)和十四位女性(45.2%)。經統計後發現，頭頸部肉瘤最常好發的部位爲下顎骨（十三位）、上顎骨（七位）及頸部（七位）。最常見的病灶爲十一例惡性纖維組織細胞瘤(Malignant fibrous histiocytoma)及八例骨肉瘤(Osteosarcoma)。三十一位患者中，有二十八位病人接受手術，其中九位術後有局部復發，四位有遠端轉移。手術邊緣腫瘤侵犯(P=0.006)及局部復發(P=0.010)爲主要死亡原因。在此次病例分析中，頭頸部肉瘤患者五年的存活率爲50%。在13個手術邊緣呈現腫瘤侵犯的病人中，六個病人有局部復發，平均發生在術後20個月，其五年存活時間平均爲33個月。本報告病例中，年輕至中年（＜50歲）的女性病人其存活率較低，但與統計上的差異。造成病灶軟組織邊緣切除不足的原因可能與性別、年齡及美觀等因素考量相關。

關鍵字

肉瘤；頭部；頸部；手術切緣；腫瘤復發

並列摘要

The aim of this study is to report our experience in the treatment of head and neck sarcomas. The medical charts and histopathologic features of thirty- one head and neck sarcomas at Taichung Veterans General Hospital between 1982 and 2007 were reviewed. Seventeen (54.8%) of the patients were male, while 14 (45.2%) were female. The common sites were the mandible (n=13), maxilla (n=7) and neck (n=7). Malignant fibrous histiocytoma (n=11) and osteosarcoma (n=8) are the most common lesions. Surgical resections were performed in 28 cases. Among them, local recurrence was found in 9 patients, and distant metastasis was proved in 4 patients. The overall 5-year survival rate was 50%. Surgical margin involvement and local recurrence were the main causes of death (P=0.006 and P=0.010, respectively). Of 13 patients with margin involvement, six developed local recurrence within a mean period of 20 months; and the mean survival period of expired patients with margin involvement was 33 months. In our series, young-to-middle-aged (＜50 years) females had poor 5-year survival rates (30%). Inadequate soft tissue margin resection may be due to gender, age and cosmetic concerns.

並列關鍵字

sarcoma ； head ； neck ； surgical margin ； recurrence

國際替代計量

The Prognostic Significance of Adequate Surgical Margin for Head and Neck Sarcomas: A Retrospective Study of Thirty-one Cases

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