复发性腹膜后肉瘤的手术治疗探讨

背景与目的：腹膜后肉瘤是罕见的恶性肿瘤,彻底手术切除是最有效的治疗方法,但是其术后复发率很高。复发性腹膜后肉瘤通常在复查时被发现,治疗方法仍是手术切除,但由于其解剖层次不清,因此手术难度大,出血多。该研究旨在探讨复发性腹膜后肉瘤的诊断及手术方式。方法：回顾性分析2007年10月—2016年10月收治的25例复发性腹膜后肉瘤,根据手术情况分组后使用log-rank检验对完整切除组与部分切除或活检组两者进行单因素预后分析,并使用Kaplan-Meier法计算生存率。结果：全组25例完整切除16例,占64.0%(16/25),部分切除6例,占24.0%(6/25),未切除活检为3例,占12.0%(3/25)。完整切除中联合脏器切除8例,占完整切除的50.0%(8/16)。24例获随访,完整切除和部分切除两者5年生存率为56.3%(9/16)和20.0%(1/5),差异有统计学意义(P<0.05)。结论：手术切除是治疗复发性腹膜后肉瘤最有效的方法,联合脏器切除能提高肿瘤完整切除率。本病术后复发率高,术后需密切随访。     

腹膜后脂肪肉瘤中中性粒细胞与淋巴细胞比值及其他预后相关因素分析

 目的 探讨中性粒细胞与淋巴细胞比值（NLR）在腹膜后脂肪肉瘤预后中的作用及其他影响预后的相关因素。方法 收集109例腹膜后脂肪肉瘤确诊病例。分析患者手术前外周血NLR的高低，将其分为高NLR组（NLR>2.78）和低NLR组（NLR≤2.78），比较两组的生存率。进一步分析NLR相关的其他临床病理特征因子，分析腹膜后脂肪肉瘤其他预后相关因素，包括患者病史、肿瘤及手术实施情况。结果 高NLR组和低NLR组的5年生存率分别为50%和84.6%（P=0.016）。高NLR组患者的肿瘤恶性程度更高（P=0.033），其次NLR的高低与患者的免疫力、炎性反应和肝功能密切相关（P=0.001, P=0.000）。此外，高NLR组中去分化型和高分化型腹膜后脂肪肉瘤分别占62.07%和13.79%，低NLR组中去分化型和高分化型腹膜后脂肪肉瘤分别占40%和48.75%（P=0.004）。在其他腹膜后脂肪肉瘤患者预后因素中，吸烟史和饮酒史的患者预后更差（P=0.032, P=0.004），同时男性和女性患者的5年生存期分别为45.5%和84.6%（P=0.006）。另外，手术切除状态结果分析显示，分块切除、姑息切除和完整切除的患者5年生存率分别为66.7%、90%和20%（P=0.027）。结论 NLR可作为腹膜后脂肪肉瘤预后指标，术前NLR>2.78提示患者预后不良。有吸烟和饮酒史的患者腹膜后脂肪肉瘤预后不良率更高，姑息切除手术的患者5年生存率高于分块切除和完整切除手术患者。     

Supratentorial gangliogliomas: histopathologic grading and tumor recurrence in 184 patients with a median follow-up of 8 years

BACKGROUND: Supratentorial gangliogliomas (GGs) are rare tumors of the central nervous system and are commonly associated with chronic seizures. To date, only case reports and small series of patients with short-term follow-up have been available for the assessment of the potential of GGs to recur and progress. METHODS: Data from 184 patients who underwent resection of GGs between 1988 and 2001 were available from the University of Bonn Epilepsy Surgery Center (Bonn, Germany). Analysis of factors that influenced tumor recurrence and patient survival, such as preoperative history, age at operation, tumor location, histopathologic findings (including immunohistochemical findings), extent of tumor resection, and recurrence evaluated on postoperative magnetic resonance imaging (MRI), was performed. RESULTS: The median follow-up period was 8 years (range, 1-14 years). One hundred seventy-eight patients (97%) presented with long-term seizures (> or = 2 years). The median age at surgery was 26 years (range, 2-65 years). Tumor location was temporal in 79% of patients and frontal in 12% of patients. Eleven tumors (6%) were classified as World Health Organization (WHO) Grade 2 lesions, and 2 tumors were classified as anaplastic WHO Grade 3 lesions. For 38 patients (21%), postoperative MRIs revealed residual tumors. Two years after surgery, 5 patients (3%) experienced tumor recurrence, which resulted in malignant progression in 3 patients (2%) and death in 2 patients (1%). Eighty-four percent of patients with epilepsy had complete and sustained seizure relief. The calculated 7.5-year recurrence-free survival rate was 97%. Lower rates of recurrence were found in patients with tumors classified as WHO Grade 1 lesions (P < 0.0001), patients with temporal lesions (P < 0.0001), patients who underwent complete tumor resection (P = 0.0278), and patients with long-standing epilepsy (P < 0.0001). CONCLUSIONS: Supratentorial GGs are benign tumors, and the surgical goal for patients with GG should be complete resection. Residual tumor masses, frontal tumor location, and WHO Grade 2 or 3 lesions are associated with a greater risk of recurrence or malignant progression. Patients with such characteristics should be considered for long-term clinical follow-up using MRI. .     

Radiotherapy as an alternative to surgery in elderly patients with resectable lung cancer

From 1978 to 1983, 50 patients with a peripherally located non-small cell tumor of the lung were irradiated with curative intent. These patients were not operated upon because of poor cardiac or pulmonary condition, old age or refusal to operate. Mean age was 74 years, 40 patients being over 70 years of age. All patients had T1-2 N0M0 tumors according to the AJC classification and received 60 Gy to the primary tumor only. The overall response rate was 90%, with 50% complete responses in tumors smaller than 4 cm. The crude overall survival rates were 56% at 2 years and 16% at 5 years, with a median survival of 27 months. Age did not influence survival. There was a strong correlation of survival to tumor size, with 5-year survival rates of 38, 22, 5 and 0% in tumors with diameters of less than or equal to 2, 2-3, 3-4 and greater than 4 cm respectively. Only 5 out of 20 complete responders had a local recurrence, the 5-year survival in this group was 42%. These results compared favorably to a group of 86 patients over 70 years of age who were selected for operation in the same hospital. The 2- and 5-year survival rates in these patients were 48 and 26% respectively, median survival being 23 months. We conclude that in patients over 70 years of age with resectable lung cancer, radiotherapy with curative intent should be offered as an alternative to operation, especially if the tumor is not larger than 4 cm.(ABSTRACT TRUNCATED AT 250 WORDS)     

Malifnant fibrous histiocytoma: a retrospective study of 167 cases

A retrospective study of 167 patients with soft-tissue malignant fibrous histiocytoma of the trunk, extremities, and retroperitoneal region revealed twice as many deeply situated tumors as superficial tumors. Malignant fibrous histiocytoma may be subclassified into fibrous, giant-cell, myxoid, and inflammatory variants. The fibrous variant accounted for two-thirds of the lesions. The prognosis is no different among the histologic subtypes. The depth of the tumor significantly affects survival, and three important groups were identified: superficial tumors, superficial tumors that recur in deep locations, and deeply situated tumors. The group with superficial tumors that subsequently did not recur in deep locations had a significantly better 4-year survival rate than did the other two groups (65% versus 34% and 40%, respectively). Patients with distally located tumors had a better 5-year survival rate than did patients with proximally located tumors (73% versus 28%). Local recurrence was found in 51% of patients who had a "complete" excision. Patients with superficial tumors had a higher local recurrence rate (71%) than did those with deep tumors (41%). Few patients with retroperitoneal tumors were long-term survivors; the 5-year survival rate was 14%.     

Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma

BACKGROUND: The impact of radical bowel resection with multiple organ resection on the survival if patients with advanced ovarian carcinoma has not been well defined. The authors investigated whether primary cytoreductive surgery including rectosigmoid colon resection would affect the recurrence free interval and survival of these patients. METHODS: Between April 1990 and April 1997, 66 previously untreated Stage IIIC-IV ovarian carcinoma patients with macroscopic involvement of the rectosigmoid colon were enrolled. All patients underwent cytoreductive surgery with rectosigmoid colon resection to remove residual tumor less than 2 cm in greatest dimension and received 6 cycles of cisplatin-based postoperative chemotherapy. RESULTS: The median follow-up was 26 months (range, 7-104 months). In multivariate analysis, residual disease and depth of tumor infiltration of the bowel wall were independently associated with overall survival and recurrence free interval. Disease stage was independently associated only with overall survival. Residual tumor was the most strongly predictive factor for recurrence or death. The 2-year estimated survival rates according to the amount of residual tumor were 100% for 24 patients with no macroscopic residual disease and 77.3% for 28 patients with residual disease less than 1 cm. None of the 14 patients with residual disease larger than 1 cm were alive 2-years after operation. Overall, 48 patients (72.7%) developed disease recurrence: 43 (65.1%) in the abdomen, 19 (29.8%) in the liver, and 3 (4.5%) in the pelvis. CONCLUSIONS: The current findings suggest that cytoreductive surgery with rectosigmoid colon resection should be considered for ovarian carcinoma patients with bulky pelvic disease to help ensure that they are left with no residual disease after debulking surgery.     

Retroperitoneal soft tissue sarcoma: prognostic factors and therapeutic approaches

AIMS AND BACKGROUND: Retroperitoneal sarcomas are a rare group of malignant soft tissue tumors with a generally poor prognosis. The aim of the study was to assess clinical, pathological and treatment-related factors affecting prognosis in patients with retroperitoneal sarcomas. METHODS AND STUDY DESIGN: The hospital records of 73 patients who underwent surgical exploration at our unit for primary retroperitoneal sarcomas between 1984 and 2003 were reviewed. Factors influencing overall and disease-free survival were analyzed for all patients and for those who underwent complete surgical resection. RESULTS: The complete resectability rate was 69.8% (51/73). Operative mortality and morbidity rates were 2.7% and 21.9%, respectively. For patients who underwent complete resection, the 5-year survival rate was 58.3%, whereas it was 0% in cases of incomplete or no resection (P < 0.001). Local recurrence rate was 37.2%. Incomplete gross surgical resection and microscopic infiltration of margins were the most important independent predictors of a poor prognosis. CONCLUSIONS: The present study confirmed the importance of an aggressive surgical management for retroperitoneal sarcomas to offer these patients the best chance for long-term survival.     

Outcomes in a series of 103 retroperitoneal sarcomas

AIMS: To report the effect on outcome of selection in patients receiving intra-operative electron beam radiation (IOERT) and external beam radiation therapy (EBRT). METHODS: One hundred and three patients treated for primary RS were studied. Median follow-up was 27 months. Clinical presentation, tumor characteristics, and treatment methods were analyzed to determine impact on survival and recurrence and if selection was occurring. RESULTS: Mean age was 55+/-17 years. Mean tumor size was 15+/-6cm and 88 were high-grade. Complete gross tumor resection (CR) occurred in 62 patients and improved survival vs. both debulking (p=0.0005) and biopsy (p<0.0001). The 5- and 10-year survival rates were 62% and 52% for those with CR vs. 29% and 20% after incomplete resection. Among the 62 CR patients, there was selection to receive additional EBRT+/-IOERT in patients with high-grade tumors (p=0.005) and/or microscopically positive margins (p=0.011). In these high-risk patients there was a trend for IOERT to further augment survival vs. EBRT alone and to increase the time to both local and distant recurrences (p=0.036). CONCLUSIONS: Complete gross resection is the primary form of curative treatment for retroperitoneal sarcomas. Selection led to patients with high-risk tumors receiving additional radiation therapy. There appears to be a beneficial effect of IOERT plus EBRT in these high-risk patients after complete tumor resection.     

原发性腹膜后肿瘤600例临床研究

[目的]总结原发性腹膜后肿瘤(PRPT)临床治疗经验,分析影响PRPT术后效果的因素。[方法]回顾性分析解放军总医院600例PRPT的临床资料。[结果]600例PRPT中546例行手术,病理结果恶性369例,良性177例。366例获随访,随访时间1个月～15年。PRPT完全切除者的1、3、5年生存率分别为:90.5%、73.2%、53.6%,恶性PRPT部分切除者的1、3、5年生存率分别为:70.6%、32.0%、5.7%(P<0.01)。Cox多因素回归分析显示:PRPT的局部复发、生存期与肿瘤是否完全切除、肿瘤大小、肿瘤细胞的分化程度明显相关。[结论]充分做好PRPT手术前准备,提高肿瘤完全切除率,是降低PRPT肿瘤复发,提高生存率的关键。     

Effectiveness of hepatic resection for early-stage hepatocellular carcinoma in cirrhotic patients: subgroup analysis according to Milan criteria

BACKGROUND: The aim of this study was to determine the long-term post-resection outcomes for cirrhotic patients with early-stage hepatocellular carcinoma (HCC). METHODS: A total of 217 < or = 65-year-old cirrhotic patients who underwent hepatic resection were divided into four groups in accordance with the Milan criteria: Group 1, those who met the Milan criteria (n = 130); Group 2A, those with a solitary tumor > 5 cm in size (n = 12); Group 2B, those with 2 or 3 tumors > 3 cm in size (n = 35); and Group 2C, those with > or = 4 tumors (n = 33). Overall and recurrence-free survival were compared between the groups. RESULTS: At 1, 3, 5 and 10 years, overall survival rates were 91, 67, 45 and 12%, and recurrence-free survival rates were 62, 26, 16 and 0%, respectively. Independent prognostic factors for overall survival were age, blood transfusion, tumor number, tumor size and microscopic vascular invasion; and for recurrence they were hepatitis C infection, tumor number, tumor size, microscopic vascular invasion and histological tumor grade. Group 1 patients had significantly better survival (5-year survival rate, 56%) than those of other groups (5-year survival rate, around 30%). The median tumor-free survival time was significantly shorter in Groups 2B and 2C (0.7 years and 0.6 years, respectively) than in Groups 1 and 2A. CONCLUSIONS: Hepatic resection can confer a considerable overall survival benefit for cirrhotic patients with HCC who meet the Milan criteria. For patients with HCC who do not meet the criteria, however, hepatic resection has limited efficacy. We suggest that application of non-surgical therapy or expansion of the indications for liver transplantation may be warranted for such patient subsets.     

肺上沟瘤的治疗进展

肺上沟瘤(Pancoast瘤)是非小细胞肺癌的一个独特的临床亚型.术前放疗加手术切除经典治疗模式在临床上应用有近40年的历史,但手术完整切除率和5年生存率仍分别徘徊在50%和30%左右.近年来,外科术式的改进使针对不同位置的肿瘤切除有更佳的选择,同时新术式的出现使完整切除受累的锁骨下血管甚至椎体成为可能.术前同期放化疗的应用不仅提高了肿瘤的完整切除率和局部控制率,而且延长了患者的中位生存时间,这种综合治疗方法正逐渐成为肺上沟瘤新的治疗模式.     

原发性腹膜后肿瘤600例临床研究(英文)

目的总结原发性腹膜后肿瘤(PRPT)临床诊断治疗经验,分析影响 PRPT 手术效果和预后的因素。方法回顾性分析解放军总医院600例 PRPT 的临床诊断、手术治疗、疗效和预后。结果 600例 PRPT 中546例行手术,肿瘤全部切除326例(占59.7%),肿瘤部分切除192例,肿瘤未切除取活检28例。同时行联合脏器切除于术113例(占20.7%)。PRPT 完全切除组的1、3、5年生存率分别为:90.5%、73.2%、53.6%,恶性 PRPT 部分切除组的1、3、5年生存率分别为:70.6%、32.0%、5.7%(P<0.01)。Cox 多因素回归分析显示:PRPT 的局部复发、生存期与(1)肿瘤是否完全切除;(2)肿瘤大小;(3)肿瘤细胞的分化程度明显相关。结论充分做好 PRPT 手术前准备,提高肿瘤完全切除率,是降低 PRPT 肿瘤复发,提高生存率和预后的关键。     

胃肠道外间质瘤临床病理特征、治疗方法对预后的影响

目的:分析胃肠道外间质瘤(extra-gastrointestinal stromal tumors,EGIST)的临床特征、手术方式和伊马替尼治疗对患者生存率的影响。方法:回顾性总结2010年01月至2018年12月我院收治的40例胃肠道外间质瘤患者的临床资料。计量和计数资料分别采用t检验和χ2检验,生存情况采用寿命表法和Kaplan-Meier法。结果:全组胃肠道外间质瘤（EGIST）患者术后中位随访时间为24个月（3~76个月）,1、3、5年生存率分别为75%、42%、35%。R0术后服用伊马替尼组3例患者1、2、3生存率100%、100%、100%;R0术后未服用伊马替尼组14例患者1、2、3生存率100%、91.0%、91.0%;非R0术后服用伊马替尼组12例患者1、2、3生存率91.7%、50.3%、33.5%;非R0术后未服用伊马替尼组11例患者1、2、3年生存率18.2%、9.0%、0;差异有统计学意义（P=0.000)。结论:EGIST具有低的发病率,预后差。手术方式、肿瘤是否破裂、有无复发转移、危险度分级、术后靶向药物治疗等是影响 EGIST 预后的重要因素。     

全胃切除术与近端胃大部切除术治疗胃底贲门癌的远期疗效对比

目的 探讨不同术式治疗胃底贲门癌的远期疗效.方法 对58例胃底贲门癌患者采用手术治疗,其中全胃切除术29例,近端胃大部切除术29例.分析比较2组患者术后并发症和5年生存率.结果 全胃切除术和近端胃大部切除术患者3年生存率分别为62.07%和44.83%(P>0.05),5年生存率为48.28%和20.69%(P<0.05).近端大部切除组的反流性食管炎发生率为75.86%,高于全胃切除组的34.48%(P<0.05);2组患者的其他并发症发生率无统计学差异.肿瘤>3.0 cm和淋巴结转移患者全胃切除后5年生存率高于近端大部切除组(P<0.05),其他情况2组的生存率比较无差异.结论 对胃底贲门癌患者实施全胃切除术治疗能够有效提高患者的长期生存率,尤其是对于肿瘤>3.0 cm和出现淋巴结转移的患者.     

Intracranial Ependymomas in Adult Patients: Analyses of Prognostic Factors

Objective: The goal of our study is to identify significant prognostic factors for a series of intracranial ependymomas in an adult population. Age, location, histology, preoperative clinical status, extent of resection and radiotherapy were examined. Methods: Our series includes 34 patients. Ten tumors were located in the brain parenchyma, 5 in the lateral ventricle, 8 in the third and 11 in the fourth ventricle. Seventeen ependymomas were grades 2 and 17 were anaplastic. Surgical resection was gross-total in 27 patients and partial in 7. Results: At a mean follow-up of 9 years (±1 year) 16 patients died and, among the 18 survivors 14 are in complete remission and 4 present a local recurrence. The 5- and 10-year overall survival rates were respectively 62% and 43%. The 5- and 10-year progression-free survivals were 47% and 43%. Univariate analysis revealed that location in the brain parenchyma and anaplasia are the only statistically significant predictors of poor outcome. Conclusion: We can make out three groups of patients from our series: the first encompasses patients operated on for an intraparenchymal tumor, in all our cases an anaplastic ependymoma, with a 5-year rate of tumor-related deaths of 100%. The second group includes fourth ventricle ependymomas, which are mostly grade 2 tumors. They display a 10-year survival rate of 90%. Last group entails lateral and third ventricle ependymomas, of both low and high grade, with a 10-year survival rate of 60% for lateral ventricle and 35% for third ventricle tumors.     

75例腹膜后软组织肉瘤的临床分析

目的　分析腹膜后软组织肉瘤的预后和放射治疗作用。方法　 75例中 ,5 0例为首程治疗 ,2 5例为局部复发后再治疗。 5 0例初治患者均接受手术治疗 ,其中 13例接受术后放射治疗。 2 5例外院术后复发再治疗患者有 16例接受手术 ,其中 3例接受术后放射治疗 ,另 9例接受单纯放射治疗。结果　全组、初程和复发再治疗患者的 5年总生存率分别为 39%、4 0 %和 37%。全组患者手术完整切除、部分切除和未切除的 5年生存率分别为 5 2 .7%、36 .6 %和 0 % ;完整切除和部分切除或未切除的生存率间差异有显著性意义 (P值分别为 0 .0 0 7、0 .0 0 0 ) ,但部分切除与未切除的 5年生存率间差异无显著性意义 (P =0 .196 )。手术完整切除的 4 1例患者 ,未放射治疗和放射治疗的 5年局部复发率分别为4 7%和 6 0 % (P =0 .880 ) ,5年生存率分别为 5 1%和 6 0 % (P =0 .780 )。手术部分切除和未切除的 2 5例患者 ,未放射治疗和放射治疗的 5年生存率分别为 17%和 4 4 % (P =0 .15 1)。结论　腹膜后软组织肉瘤的治疗以手术为主 ,手术完整切除可显著提高生存率。常规体外放射治疗的作用尚不肯定     

Surgery of small hepatocellular carcinoma. Analysis of 144 cases

A long-term follow-up study of 144 cases with surgically and pathologically proved small hepatocellular carcinoma (less than or equal to 5 cm) from 1967 to 1987 is reported. One hundred eight cases (75.0%) were detected by alpha-fetoprotein serosurvey and/or ultrasonography mainly in a high-risk population; 129 cases (89.6%) coexisted with cirrhosis. Resection was done in 132 cases (91.7%) with three (2.3%) operative deaths; cryosurgery, laser vaporization, and hepatic arterial chemotherapy were used in the rest. Limited resection was done in 67.4% of resections. Reresection of subclinical recurrence or solitary pulmonary metastasis was done in 21 cases. The 5-year and 10-year survival rates were 67.9% and 53.4% in the resection group but zero in the nonresection group. Survival was correlated negatively with tumor size, 5-year survival after resection was 84.6% in tumors less than or equal to 2 cm but 59.5% in tumors of 4.1 to 5 cm. The increase of resectability and reresection resulted in marked improved of 5-year survival from 43.5% in 1973 to 1977 to 63.3% in 1978 to 1982 in the entire series. No significant difference was found between survival of limited resection and lobectomy. Resection may be the modality of choice for treatment of small hepatocellular carcinomas with compensated liver function. Limited resection instead of lobectomy was the key to increased resectability and decreased operative mortality in cirrhotic livers. Reresection of subclinical recurrence was important to prolong survival further.     

Evaluation of the frequency and pattern of local recurrence following intersphincteric resection for ultra-low rectal cancer

IntroductionAbdomino-perineal resection has been the standard treatment for rectal tumors located ⩽5 cm from the anal verge. Recently, intersphincteric resection became a valid option which preserves the bowel continuity with better functional outcome.AimIs to evaluate the oncological and functional outcome alongside the associated surgical morbidity in patients with T1-3 rectal cancer, who underwent intersphincteric resection (ISR).Patients & methodsBetween the years 2006 and 2011, 55 patients with invasive rectal adenocarcinoma, T1-3 lesions, located 2–5 cm from the anal verge underwent ISR with total mesorectal excision. When inevitable, complete. ISR was performed, otherwise partial ISR was done. All T3 patients underwent total meso-rectal excision (TME) while some had lateral lymph node dissection (LND) with concomitant pelvic autonomic nerve preservation (PANP).ResultsAmong the 55 patients, 21 (38.1%) patients were T1-2 and 34 (61.9%) patients were T3. The tumor location range was 0–5 cm from the anal verge (median 2.3 cm). Partial or complete ISR was done for 35 (63.6%) and 20 (36.4%), respectively. Patients were followed for a median of 1.5 years (range 1–4.6 years). The 3 year local recurrence and distant metastasis free rates were 85.2% and 85.6%, respectively. All the 3 local recurrences occurred in T3 patients group, and had positive circumferential resection margins. Overall 3-year disease-free survival was 82.6%; while the overall 3-year survival was 88.7%.ConclusionIntersphincteric resection with TME does not affect the local recurrence or overall survival rate in early rectal cancer T1-2 & 3, with preservation of bowel continuity and better life quality.     

原发性腹膜后肿瘤600例临床研究

目的总结原发性腹膜后肿瘤(PRPT)临床诊断治疗经验,分析影响PRPT手术效果和预后的因素。方法同顾性分析解放军总医院600例PRPT的临床诊断、手术治疗、疗效和预后。结果600例PRPT中546例行手术,肿瘤全部切除326例(占59.7%),肿瘤部分切除192例,肿瘤未切除取活检28例。同时行联合脏器切除手术113例(占20.7%)。PRPT完全切除组的1、3、5年生存率分别为:90.5%、73.2%、53.6%,恶性PRPT部分切除组的1、3、5年牛存率分别为:70.6%、32.0%、5.7%(P<0.01)。Cox多因素回归分析显示:PRPT的局部复发、生存期与(1)肿瘤是否完伞切除;(2)肿瘤大小;(3)肿瘤细胞的分化程度明显相关。结论充分做好PRPT手术前准备,提高肿瘤完全切除率,是降低PRPT肿瘤复发,提高生存率和预后的关键。     

Prognostic factors in retroperitoneal sarcomas: ploidy of DNA as a predictor of clinical outcome.

BACKGROUND AND OBJECTIVES: Radical surgery is the best mode of treatment of retroperitoneal sarcomas (RS); however, common recurrences are unpredictable. METHODS: For the better understanding of outcomes and possibilities of treatment retrospective analysis of different factors, including DNA content, was performed based on 70 patients. RESULTS: Leiomyosarcoma and liposarcoma were most common histologic types of classified sarcomas. Different kinds of resection were successfully performed in 51 patients (73%) and 35 of their available DNA specimens were analyzed. The actuarial 5- and 10-year survival rates in the resection group were 53% and 40%, respectively, with the median survival of 57 months. Patients with diploid resected tumors had a better 10-year survival rate (58%), than those patients with aneuploid tumors (25%,)--P<0.005. Those patients with low-grade sarcomas had a significantly longer survival than those with high-grade sarcomas (10-year survival rate: 44% compared to 29%). In the univariate analysis, adjuvant therapy, type of histology, type of surgery, location of tumor, and S-phase fraction had no influence on survival. In the multivariate analysis (Cox), only ploidy was an independent prognostic variable. Relative risk of death was over three times higher for aneuploid than for diploid tumors. CONCLUSION: Tumor ploidy should be analyzed in every case of retroperitoneal sarcoma for better assessment of prognosis and possible indication for adjuvant therapy.