骨与软组织肉瘤肺转移的单中心大样本外科治疗结果及预后分析

摘要

背景与目的肺是骨与软组织肉瘤最常见的远隔转移脏器，肺转移严重影响患者长期生存。肺转移瘤切除术有助于改善预后，然而对其临床地位、适应证及预后影响因素的认识目前仍存在争议。由于发病率较低难以开展随机对照研究，同时国际单中心大宗病例回顾研究也极为罕见，国内尚无类似报道。本研究旨在回顾本组单中心大样本肺转移性骨与软组织肉瘤的外科治疗结果，并且对预后影响因素进行分析。方法2007年1月-2015年12月期间，经病理确诊为骨与软组织肉瘤，已在多学科综合治疗框架下完成原发病灶根治性切除，并且至少经过1次肺转移瘤切除术的所有患者均纳入分析。收集相关临床变量，运用Cox风险比例回归法进行单因素及多因素分析寻找与预后影响因素。结果144例骨与软组织肉瘤患者符合纳入标准，总共行155次肺转移瘤切除术。多因素分析结果提示非R0切除、无病间期<1年、肺转移灶数目≥3枚、肺转移灶的长径总和≥45 mm均是预后的独立危险因素。结论积极行肺转移瘤外科治疗有助于改善转移性骨与软组织肉瘤患者的长期预后。R0切除，无病间期时间较长，转移瘤数目较少及长径总和较小是本组患者良好的预后因素。%Background and objective hTe bone and sotf tissue sarcoma can metastasize to distant sites, most commonly the lungs. Some cases can be cured by radical metastasectomy, but its role, indication and prognostic factors remains controversial. hTe rarity of the disease combined with the diverse number of subtypes can make bone and sotf tissue sarco-mas very diffcult to study. hTere are few randomized control studies or international high volume results, and such reports in China are seldom seen. hTe aim of this study is to investigate surgical treatment outcomes and prognostic factors of pulmonary metastatic bone and sotf tissue sarcoma patients.Methods From January 2007 to December 2015, patients with bone and sotf tissue sarcoma who underwent multimodality therapy including deifnitive surgery for the primary lesion and at least one pulmonary metastasectomy were enrolled in the retrospective study. All the relevant clinical variables were collected, and then statistically analyzed and interpreted with the aid of univariate and multivariateCox proportional hazard regression method. ResultsTotally 155 pulmonary metastasectomies in 144 patients were analyzed. Incomplete R0 resection, a less than 1-year interval from a previous surgery, more than three detected nodules; and the summed maximum diameter of more than 45 mm for pulmonary metastases were independent prognostic indicators by multivariate analysis.Conclusion We suggest that meta-static bone and sotf tissue sarcoma patients can beneift most from aggressive surgical intervention of pulmonary metastasec-tomy. Its prognostic factors include R0 resection, a longer interval from a previous surgery, smaller total number and total size of pulmonary metastases.