■对于局部复发的四肢或躯干软组织肉瘤(STS)患者,需要改进的预后工具。
■研究局部复发性四肢或躯干STS切除后平均局部复发(LR)增长率与结局之间的关系。
■这项回顾性队列研究使用了来自美国单个高容量三级肉瘤转诊中心的前瞻性维护数据库,以确定在1982年7月1日至2021年12月31日期间接受局部复发性四肢或躯干STS重复切除术的16岁或以上患者。非典型脂肪瘤患者,硬纤维瘤,隆突性皮肤纤维肉瘤,血管肉瘤,排除先前或同步的远处复发。数据从2022年11月1日至2024年6月17日进行了分析。
■平均LR增长率,定义为复发肿瘤最大直径的总和除以索引手术后的无病间隔。
■主要结局是疾病特异性死亡(DSD)的累积发生率,其他原因导致的死亡是一种相互竞争的风险,和第二个LR,任何原因导致的死亡都是一种相互竞争的风险。
■该研究队列包括253名患者(中位[IQR]年龄,64[51-73]岁;140[55.3%]男性)。再次切除后DSD的5年累积发生率为29%。多变量分析表明,LR增长率(危险比[HR],1.12[95%CI,1.08-1.18];P<.001),年龄较小(HR,0.98[95%CI,0.97-0.99];P=.002),R1或R2边距(HR,1.71[95%CI,1.03-2.84];P=.04),高LR等级(HR,2.90[95%CI,1.17-7.20];P=0.02),和多焦点(HR,2.92[95%CI,1.70-5.00];P<.001)与较高的DSD发生率独立相关。使用最小P值方法,生长速率的最佳截止值为0.68cm/mo。超过该临界值的患者在重复切除后5年DSD发生率更高(63%vs19%;排列检验P<.001),截肢率更高(19%vs7%;P=.008)。只有R1边缘与第二LR的较高发生率独立相关(HR,1.81[95%CI,1.19-2.78];P=.006)。
■在这项接受局部复发性四肢或躯干STS切除的患者的队列研究中,LR生长速率与DSD独立相关。这些结果表明,生长速度高于0.68cm/mo的患者接受LR切除可能具有较高的疾病特异性死亡率和截肢率,应考虑进行围手术期全身治疗。
UNASSIGNED: Improved prognostic tools are needed for patients with locally recurrent extremity or truncal soft tissue sarcoma (STS).
UNASSIGNED: To examine the association between average local recurrence (LR) growth rate and outcomes following resection of locally recurrent extremity or truncal STS.
UNASSIGNED: This retrospective cohort study used a prospectively maintained database from a single high-volume tertiary sarcoma referral center in the US to identify patients 16 years of age or older who underwent repeat resection of a locally recurrent extremity or truncal STS between July 1, 1982, and December 31, 2021. Patients with atypical lipomatous tumors, desmoid tumors, dermatofibrosarcoma protuberans, angiosarcomas, and prior or synchronous distant recurrence were excluded. Data were analyzed from November 1, 2022, to June 17, 2024.
UNASSIGNED: Average LR growth rate, defined as the sum of recurrent tumor maximal diameters divided by the disease-free interval after index operation.
UNASSIGNED: The primary outcomes were cumulative incidences of disease-specific death (DSD), with death from other causes as a competing risk, and second LR, with death from any cause as a competing risk.
UNASSIGNED: The study cohort included 253 patients (median [IQR] age, 64 [51-73] years; 140 [55.3%] male). The 5-year cumulative incidence of DSD after repeat resection was 29%. Multivariable analysis indicated that LR growth rate (hazard ratio [HR], 1.12 [95% CI, 1.08-1.18]; P < .001), younger age (HR, 0.98 [95% CI, 0.97-0.99]; P = .002), R1 or R2 margins (HR, 1.71 [95% CI, 1.03-2.84]; P = .04), high LR grade (HR, 2.90 [95% CI, 1.17-7.20]; P = .02), and multifocality (HR, 2.92 [95% CI, 1.70-5.00]; P < .001) were independently associated with higher incidence of DSD. Using the minimum P value method, the optimal cutoff for growth rate was found to be 0.68 cm/mo. Patients with values above this cutoff had higher 5-year incidences of DSD following repeat resection (63% vs 19%; permutation test P < .001) and higher amputation rates (19% vs 7%; P = .008). Only R1 margins were independently associated with higher incidence of second LR (HR, 1.81 [95% CI, 1.19-2.78]; P = .006).
UNASSIGNED: In this cohort study of patients undergoing resection of a locally recurrent extremity or truncal STS, LR growth rate was independently associated with DSD. These findings suggest that patients with growth rates higher than 0.68 cm/mo who undergo LR resection may have high disease-specific mortality and amputation rates and should be considered for perioperative systemic therapy.