背景:未分化多形性肉瘤(UPS)是一种相对罕见但侵袭性肿瘤。我们试图利用多机构美国肉瘤患者队列来检查UPS切除术后生存和复发模式的预测因素。
方法:回顾性分析了2000年至2016年在7个学术机构接受根治性手术切除的原发性UPS患者。流行病学和临床病理因素按来源地点进行了审查。总生存期(OS),无复发生存率(RFS),时间到局部区域(TTLR),远处复发时间(TTDR),并对复发模式进行了分析。
结果:在确定的534例UPS患者中,53%是女性,中位年龄60岁,中位肿瘤大小8.5cm。中位数OS,RFS,TTLR,整个队列的TTDR分别为109、49、86和46个月,分别。四肢和躯干UPS之间的这些生存结果没有差异。与躯干相比,四肢UPS更适合R0切除(87%vs.75%,p=0.017),与淋巴结转移较不常见(1%vs.6%,p=0.031)。R0切除和放射治疗,但不是原产地(四肢与主干)是OS和RFS的独立预测因子。对于切缘阳性的UPS切除和未接受放射治疗的肿瘤,TTLR复发较短。
结论:对于切除四肢和躯干UPS的患者,肿瘤大小>5cm和切缘阳性与生存OS和RFS较差相关,不管是原产地。R0手术切除和放射治疗可能有助于改善这些生存结果。
BACKGROUND: Undifferentiated pleomorphic sarcoma (UPS) is a relatively rare but aggressive neoplasm. We sought to utilize a multi-institutional US cohort of sarcoma patients to examine predictors of survival and recurrence patterns after resection of UPS.
METHODS: From 2000 to 2016, patients with primary UPS undergoing curative-intent surgical resection at seven academic institutions were retrospectively reviewed. Epidemiologic and clinicopathologic factors were reviewed by site of origin. Overall survival (OS), recurrence-free survival (RFS), time-to-locoregional (TTLR), time-to-distant recurrence (TTDR), and patterns of recurrence were analyzed.
RESULTS: Of the 534 UPS patients identified, 53% were female, with a median age of 60 and median tumor size of 8.5 cm. The median OS, RFS, TTLR, and TTDR for the entire cohort were 109, 49, 86, and 46 months, respectively. There were no differences in these survival outcomes between extremity and truncal UPS. Compared with truncal, extremity UPS were more commonly amenable to R0 resection (87% vs. 75%, p = 0.017) and less commonly associated with lymph node metastasis (1% vs. 6%, p = 0.031). R0 resection and radiation treatment, but not site of origin (extremity vs. trunk) were independent predictors of OS and RFS. TTLR recurrence was shorter for UPS resected with a positive margin and for tumors not treated with radiation.
CONCLUSIONS: For patients with resected extremity and truncal UPS, tumor size >5 cm and positive resection margin are associated with worse survival OS and RFS, irrespectively the site of origin. R0 surgical resection and radiation treatment may help improve these survival outcomes.