目的:精索肉瘤极为罕见,经常误诊,随后在当地医院治疗不当。这项回顾性研究着眼于在三级转诊肉瘤中心进行根治性切除治疗的精索肉瘤病例的肿瘤结局。我们特别研究了与参考中心的原发肿瘤切除相比,最初的不充分切除如何影响肿瘤学结果。
方法:118名连续患者受原发性,纳入了2001年1月至2021年1月在我们的参考中心手术治疗的局部精索肉瘤.主要终点为无局部复发(LRFS),无远处转移(DMFS)和总生存期(OS)。使用多元逻辑回归和Cox比例风险回归模型评估这些结果与已知患者的相关性,肿瘤和治疗相关预后因素,包括先前的不充分切除和从诊断到完全肿瘤切除的时间作为独立变量。其次,我们比较了初次手术和再切除手术亚组的上述变量和治疗间隔.
结果:中位随访54个月(IQR25-105),12例(10.2%)发生局部复发(LR),14例(11.6%)发生远处转移(DM)。5年局部复发(LRFS)和无远处转移生存率(DMFS)分别为89.3%和86.5%,分别。较高的肿瘤分级和大小与较差的DMFS相关(p=<0.05)。同样,边缘(R1)切除与下LRFS相关(p=<0.05)。84名患者(71.2%)的初步诊断是由于在当地医院进行的手术切除不充分,然后在我们中心进行再切除(再切除组)。在同一时期,34例(28.8%)主要在我们的参考中心进行活检和治疗(原发性切除组)。两组在肿瘤大小上有统计学上的显著差异,组织病理学,手术持续时间,术后并发症发生率和R0切除率(p<0.005)。此外,达到治疗目标的时间间隔差异在统计学上无统计学意义,并且与作为自变量的复发风险无关.51.2%(n=43)的再切除标本中存在残留疾病。然而,在R0完全切除后,这与较高的复发风险无关(p=0.481).
结论:迅速转诊到三级中心,多学科评估和正确的肿瘤切除是治疗的标准,可以使其他地方接受不完整手术的患者的OS和DFS与主要在转诊中心接受治疗的患者一致。预后的主要决定因素仍然是手术切缘,肿瘤大小和级别。
OBJECTIVE: Spermatic cord sarcomas are exceedingly rare, often misdiagnosed and subsequently improperly treated at local hospitals. This retrospective study looked at the oncological outcomes of spermatic cord sarcoma cases managed with curative intent resection at a tertiary referral sarcoma centre. We specifically studied how initial inadequate resections impact the oncologic outcomes compared to primary tumour resections at the reference centre.
METHODS: One hundred eighteen consecutive patients affected by primary, localized spermatic cord sarcoma surgically managed at our reference centre from January 2001 through January 2021 were included. Primary endpoints were local relapse free (LRFS), distant metastasis free (DMFS) and overall survival (OS). These outcomes were evaluated with multi-nomial logistic regression and Cox proportional hazards regression models for a co-relation to known patient, tumour and treatment-related prognostic factors, including a prior inadequate resection and time from diagnosis to a complete oncologic resection as independent variables. Secondarily, we compared the above variables and treatment intervals among the subgroups of primary versus re-resection surgery.
RESULTS: Over a median follow-up of 54 months (IQR 25-105), 12 patients (10.2%) developed local recurrence (LR) and 14 (11.6%) had distant metastasis (DM). 5-year local relapse (LRFS) and distant metastasis-free survival (DMFS) were 89.3% and 86.5%, respectively. Higher tumour grade and size were associated with a worse DMFS (p=<0.05). Likewise, marginal (R1) resection correlated with an inferior LRFS (p=< 0.05). Eighty-four patients (71.2%) had their initial diagnosis established on an inadequate surgical excision performed in a local hospital, followed by a re-excision at our centre (Re-resection group). During the same period, 34 (28.8%) were managed primarily with biopsy and treatment at our reference centre (Primary-resection group). The two groups had statistically significant differences in tumour size, histopathology, surgery duration, rate of postoperative complication and R0 resection (p < 0.005). Additionally, the difference in time intervals to achieve the treatment targets was statistically insignificant and did not correlate to the risk of recurrence as an independent variable. Residual disease was present in 51.2 % (n = 43) of the re-excision specimens. However, following a complete R0 resection, this did not correlate with a higher risk of recurrence (p = 0.481).
CONCLUSIONS: Prompt referral to a tertiary centre, where multidisciplinary evaluation and sound oncologic resections are the standard of treatment, can align the OS and DFS of patients receiving incomplete surgery elsewhere to those treated primarily in referral centres. The primary determinant of prognosis remains surgical margin, tumour size and grade.