软组织肉瘤补充广泛切除78例原因和疗效分析
Efficacy of Re-Excision for 78 Cases with Soft Tissue Sarcoma
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摘要:目的 探讨软组织肉瘤补充广泛切除术的原因及患者预后的影响。方法 回顾性分析2007年7月至2011年3月收治的外院误诊为良性肿瘤而行局部切除的原发软组织肉瘤患者78例。主要观察终点为肿瘤的复发转移, 分析肿瘤残留情况对患者预后的影响。结果 补充广泛切除术后, 中位随访时间是17.4个月, 其中复发3例, 转移5例, 死亡3例。Kaplan-Meier法计算1年无瘤生存率为93.6%, 3年无瘤生存率92.3%。初次术后肿瘤残留共40例, 占52%。初次手术后肿瘤残留组和非残留组生存无差异。结论 患者在非计划性切除后肿瘤残留率较高, 接受补充广泛切除术是必要的。补充广泛切除原因多为术前无明确病理诊断, 无影像学检查。软组织肉瘤发病率较低, 在临床上应慎重处理。Abstract:Objective To explore the outcome of patients with soft tissue sarcoma(STS) undergoing re-excision after a previous unplanned surgery.Methods Data of 78 patients who underwent radical surgery after an unplanned excision of a localized primary STS on the extremities from 2007 to 2011 were analyzed.The assessed endpoints were disease-free survivals.Results Survival data after the re-excision for all patients with a median observation period of 17.4 months(within a range of 2 months to 45 months) were obtained.Local recurrence appeared in 3 patients(4%) and distant metastasis was found in 5 patients(6%).The 1-year and 3-year disease-free survival rates were 93.6%and 92.3%, respectively.Residual tumor was detected in 40 patients(52%).The residual tumor in the surgical specimen after incomplete primary resection did not influence the incidence of local recurrence and distant metastasis.Conclusion Patients need to undergo re-excision after an unplanned resection because of the higher residual tumor rate.Therefore, patients with unknown soft tissue masses should be transferred to centers that specialize in treating sarcomas for adequate initial resection.
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