摘要
背景与目的:韧带样瘤的预后影响因素仍存在争论。既往大样本预后分析往往混杂有腹腔内韧带样瘤和手术不完整切除的情况。本文着重分析外科手术完整切除(R0,R1)的腹壁及腹壁外韧带样瘤的预后影响因素。方法:收集1987年1月—2007年12月经本院外科收治的198例韧带样瘤患者的资料,回顾性分析其中手术完整切除无肉眼残留的151例患者临床资料、随访其生存及复发情况。结果:中位随访时间为102个月,随访期间无患者死亡,总体生存率为100%。31例患者局部复发,复发率为20%。其中5年无复发生存率(recurrencefree survival,RFS)为79%,10年RFS为78%。单因素分析表明,入院情况、性别、肿瘤部位及大小、病变数目、切缘情况是影响RFS的主要因素(P<0.05)。多因素分析表明,肿瘤大小与切缘情况是影响RFS的独立预后因素。辅助放疗并不能显著提高患者的局部控制率,但切缘阳性患者可能从中受益。结论:无论是原发还是复发腹壁及腹壁外韧带样瘤患者,都应在保全肢体功能的情况下,争取做到R0切除,腹壁外韧带瘤患者较易复发,若切缘阳性,治疗应该更加积极。病变数目是局部复发的独立预后因素,多发性韧带样瘤更易复发,诊治较棘手,临床应注意多中心发病的可能性。
Background and purpose： Prognostic factors for desmoid tumors are still being disputed. Previous large investigations of the prognosis of desmoids have included tumors from intra- and extra-abdominal sites as well as incomplete resection. The purpose of this study was to focus on prognostic factors that may influence recurrence free survival （RFS） in completed surgical resected abdominal and extra-abdominal desmoid tumors. Methods： Between Jan. 1987 and Dec. 2007, 151 patients treated with macroscopically complete resection from a single institution were retrospectively reviewed. Results： The median follow-up time was 102 months. Of all the patients, 31 （20%） had local recurrence. No patients had died of the disease. The 5-year and 10-year RFS were 79% and 78%, respectively. Admitted status, gender, tumor size, margin status, location and number, were all significant factors for predicting local recurrence in univariate analysis. Tumor size and margin status were independent prognostic factors in the multivariate analysis. The selective use of adjuvant radiotherapy did not show significant benefits for local control. Conclusion： Regardless whether the disease was primary or recurrent, a microscopically negative margin should always be the goal for extra-abdominal desmoids surgery, even when no cosmetic defects or function demolition is encountered. Extra-abdominal desmoids deserve more attention and should be treated more positively, especially when leaving positive margins. Multifocal diseases have independent prognostic factors that can recur more easily and therefore need more attention.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2011年第1期61-66,共6页
China Oncology
