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Abstract：
BACKGROUND: Despite the fact that about one third of patients with primary localized extremity soft tissue sarcoma (eSTS) will develop metastatic disease, abdominal metastases (AM) and retroperitoneal metastases (RM) constitute rare events. There is no clear consensus on how to achieve follow-up on patients with primary localized eSTS following curative resection, especially regarding the surveillance of potential AM/RM.
OBJECTIVE: To systematically analyse incidence, diagnosis, treatment and outcome of AM/RM in eSTS patients.
METHODS: In this systematic review, 899 studies available in PubMed and published between 2000 and 2018 were screened, identifying 17 original articles focused on AM or RM in eSTS. Article selection was based on the PRISMA guidelines, using the search terms (abdominal metastasis AND soft tissue sarcoma) and (soft tissue sarcoma metastasis abdomen). All studies published between January 1, 2000 and December 31, 2018 were screened. Further articles were identified by cross-searching article references, with the final search date being February 18, 2019. Due to limited data and the different reporting techniques used, the present review focused on descriptive analysis of the included studies.
RESULTS: Of the 17 studies included, six original articles reported on incidence ± diagnosis, therapy and outcome in AM and RM, whilst three original and eight case reports focused on diagnostic pathway, therapeutic procedures or outcomes without allowing conclusions regarding incidence of AM and RM. According to the former six studies, incidence of AM ranged from 0.9%-5.6% in patients with miscellaneous histological subtypes, and up to 12.1% in patients with myxoid liposarcoma. The most common histological subtypes that developed AM or RM were (myxoid) liposarcoma and leiomyosarcoma, but also rare subtypes such as epithelioid sarcoma, myxofibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumour had been reported to develop AM/RM. Surgery for AM/RM was performed in five of eight case-reports (62.5%) and in 20.8%-100.0% of original articles. In particular, patients with hepatic metastases undergoing metastasectomy had a survival benefit compared to patients treated with chemotherapy or best supportive care (> 3 years vs < 6 mo).
CONCLUSIONS: Patients with eSTS should undergo surveillance with abdominal ultrasonography/computed tomography, or even whole-body-magnetic resonance imaging to detect AM/RM at an early stage.
OBJECTIVE: To systematically analyse incidence, diagnosis, treatment and outcome of AM/RM in eSTS patients.
METHODS: In this systematic review, 899 studies available in PubMed and published between 2000 and 2018 were screened, identifying 17 original articles focused on AM or RM in eSTS. Article selection was based on the PRISMA guidelines, using the search terms (abdominal metastasis AND soft tissue sarcoma) and (soft tissue sarcoma metastasis abdomen). All studies published between January 1, 2000 and December 31, 2018 were screened. Further articles were identified by cross-searching article references, with the final search date being February 18, 2019. Due to limited data and the different reporting techniques used, the present review focused on descriptive analysis of the included studies.
RESULTS: Of the 17 studies included, six original articles reported on incidence ± diagnosis, therapy and outcome in AM and RM, whilst three original and eight case reports focused on diagnostic pathway, therapeutic procedures or outcomes without allowing conclusions regarding incidence of AM and RM. According to the former six studies, incidence of AM ranged from 0.9%-5.6% in patients with miscellaneous histological subtypes, and up to 12.1% in patients with myxoid liposarcoma. The most common histological subtypes that developed AM or RM were (myxoid) liposarcoma and leiomyosarcoma, but also rare subtypes such as epithelioid sarcoma, myxofibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumour had been reported to develop AM/RM. Surgery for AM/RM was performed in five of eight case-reports (62.5%) and in 20.8%-100.0% of original articles. In particular, patients with hepatic metastases undergoing metastasectomy had a survival benefit compared to patients treated with chemotherapy or best supportive care (> 3 years vs < 6 mo).
CONCLUSIONS: Patients with eSTS should undergo surveillance with abdominal ultrasonography/computed tomography, or even whole-body-magnetic resonance imaging to detect AM/RM at an early stage.
摘要：
背景：尽管大约三分之一的原发性局部四肢软组织肉瘤（eSTS）患者会发展为转移性疾病，腹部转移(AM)和腹膜后转移(RM)是罕见事件.如何在根治性切除后对原发性局部eSTS患者进行随访尚无明确共识。特别是关于潜在AM/RM的监测。
目的：系统分析发病率，诊断,ESTS患者AM/RM的治疗和结果。
方法：在这篇系统综述中，筛选了PubMed中提供的2000年至2018年之间发表的899项研究，在eSTS中确定17篇专注于AM或RM的原创文章。文章选择基于PRISMA指南，使用搜索词（腹部转移和软组织肉瘤）和（腹部转移和软组织肉瘤）。2000年1月1日至2018年12月31日发表的所有研究均经过筛选。通过交叉搜索文章参考文献确定了更多的文章，最终搜索日期为2019年2月18日。由于有限的数据和使用的不同的报告技术，本综述集中于纳入研究的描述性分析.
结果：在纳入的17项研究中，六篇关于发病率±诊断的原创文章，AM和RM的治疗和结果，虽然三份原始报告和八份病例报告侧重于诊断途径，治疗程序或结果，而不允许关于AM和RM发生率的结论。根据前六项研究，在有其他组织学亚型的患者中，AM的发生率为0.9%-5.6%。粘液样脂肪肉瘤患者高达12.1%。发生AM或RM的最常见的组织学亚型是（粘液样）脂肪肉瘤和平滑肌肉瘤，但也有罕见的亚型，如上皮样肉瘤，粘液纤维肉瘤,滑膜肉瘤,据报道，恶性周围神经鞘瘤发展为AM/RM。在八例病例报告中的五例（62.5％）和原始文章的20.8％-100.0％中进行了AM/RM手术。特别是,与接受化疗或最佳支持治疗的患者相比,接受转移瘤切除术的肝转移患者的生存获益(>3年vs<6个月).
结论：患有eSTS的患者应接受腹部超声/计算机断层扫描的监测，甚至全身磁共振成像在早期阶段检测AM/RM。
目的：系统分析发病率，诊断,ESTS患者AM/RM的治疗和结果。
方法：在这篇系统综述中，筛选了PubMed中提供的2000年至2018年之间发表的899项研究，在eSTS中确定17篇专注于AM或RM的原创文章。文章选择基于PRISMA指南，使用搜索词（腹部转移和软组织肉瘤）和（腹部转移和软组织肉瘤）。2000年1月1日至2018年12月31日发表的所有研究均经过筛选。通过交叉搜索文章参考文献确定了更多的文章，最终搜索日期为2019年2月18日。由于有限的数据和使用的不同的报告技术，本综述集中于纳入研究的描述性分析.
结果：在纳入的17项研究中，六篇关于发病率±诊断的原创文章，AM和RM的治疗和结果，虽然三份原始报告和八份病例报告侧重于诊断途径，治疗程序或结果，而不允许关于AM和RM发生率的结论。根据前六项研究，在有其他组织学亚型的患者中，AM的发生率为0.9%-5.6%。粘液样脂肪肉瘤患者高达12.1%。发生AM或RM的最常见的组织学亚型是（粘液样）脂肪肉瘤和平滑肌肉瘤，但也有罕见的亚型，如上皮样肉瘤，粘液纤维肉瘤,滑膜肉瘤,据报道，恶性周围神经鞘瘤发展为AM/RM。在八例病例报告中的五例（62.5％）和原始文章的20.8％-100.0％中进行了AM/RM手术。特别是,与接受化疗或最佳支持治疗的患者相比,接受转移瘤切除术的肝转移患者的生存获益(>3年vs<6个月).
结论：患有eSTS的患者应接受腹部超声/计算机断层扫描的监测，甚至全身磁共振成像在早期阶段检测AM/RM。
