原发性256例软组织肉瘤手术治疗的临床分析

目的：探讨软组织肉瘤的诊断、手术治疗方法及其疗效。方法：对256例原发性软组织肉瘤患者的治疗情况进行回顾性分析。行局部广泛切除及根治切除术,对侵犯骨组织的软组织肉瘤则按微波原位灭活保肢手术处理。切除肿瘤后,行血管修复重建、带血管蒂游离皮瓣转移、局部皮瓣转移、肌腱移位、肌皮瓣移位。结果：发病年龄为20-70岁,占62.11%（159/256）,常见的病理类型为滑膜肉瘤、恶性纤维组织细胞瘤、脂肪肉瘤、横纹肌肉瘤、纤维肉瘤,占65.23%（167/256）。Kaplan-Meier法计算5年生存率为63.28%。结论：诊断采用CT、MRI为主的影像学,治疗以手术为主,辅助放疗和化疗。     

原发性腹膜后软组织肉瘤的临床分析

原发性腹膜后软组织肉瘤 (Ｐｒｉｍａｒｙｒｅｔｒｏｐｅｒｉｔｏｎｅａｌｓａｒｃｏ ｍａ ,ＰＲＳ)是一种罕见的恶性肿瘤 ,约占成人恶性肿瘤的0 1%～ 0 2 % ,患者大多预后不良 ,五年生存率约 15 %～35 % ,早期诊断非常重要 ,超声可作为首先检查。材料与方法我院 1983年 7月～ 1999年 12月的住院病例 13人 ,其中男 9例 ,女 4例 ,年龄 41～ 77岁。,全部经手术和病理证实。仪器ＥＵＢ 2 6、40、Ａｌｏｋａ 5 0 0、6 5 0型实时超声显像仪 ,探头频率 3 5ＭＨｚ。患者常规采取仰卧位 ,必要时侧卧位、俯卧位 ,对肿块所在解剖区及周邻脏器、腹膜…     

原发性腹膜后软组织肉瘤20例临床分析

原发性腹膜后软组织肉瘤是一类临床上比较罕见的局部侵袭性肿瘤。本文对１９７６～１９９３年收治２０例病人作回顾性分析：首次诊断符合率仅３０％，结合影像学检查，诊断符合率达８５％，Ｂ超和ＣＴ在诊断中价值极大。手术是治疗本病的主要手段。手术完整切除肿瘤占４５％，部分切除占２０％，活检占３５％，指出提高本病治愈率关键是完全切除肿瘤，对切除后复发者，强调再次、多次手术，以提高生存率。     

软组织肉瘤102例临床分析

软组织肉瘤国内外文献报道较少.本文对102例软组织肉瘤作了临床分析.阐明了影响软组织肉瘤疗效的主要因素有肿瘤生长部位、肿瘤大小、患者年龄、治疗方法及病理类型等.同时指出有计划地将手术与放疗、化疗相结合的综合治疗方法能发挥各自的优势,减少肿瘤的局部复发率及远处转移,是目前治疗软组织肉瘤的理想方法.     

85例软组织肉瘤回顾分析及软组织肉瘤诊治进展

目的通过近5年85例软组织肉瘤回顾分析以探索本地区软组织肉瘤的临床特点及诊治进展。方法采用经病理证实的软组织肉瘤的调查统计，对此临床资料进行回顾性发析。结果好发年龄段为30～70岁，占78-8％（67／85）；发病部位依次为下肢、躯干、腹腔、后腹膜、上肢及头颈，前3位占65．8％（56／85）；前6位病理类型为纤维肉瘤、平滑肌肉瘤、恶性纤维组织细胞瘤、皮肤隆突性纤维肉瘤、横纹肌及滑膜肉瘤，占69．4％（59／85）。常见转移部位为肺、肝、淋巴结和多发转移，远处转移占58-8％，大多属Ⅲ及Ⅳ期期局部复发近30％；预后与肿瘤大小、部位、深度、分期、分级、复发几率及转移灶数目有关。结论本组软组织肉瘤病种复杂，分布广泛，异质性明显；病期晚，肿块大且转移多见。诊断采用CT、MRI为主的影像学、病理形态学及免疫组织化学（IHC），必要时加电镜检查；治疗以手术为主，手术加放疗为基础模式，据分期、分级和生物学特性加高活性联合方案等综合治疗，软组织肉瘤靶向治疗为目前研究热点。     

184例软组织肉瘤患者不同治疗方法分析

目的 探讨软组织肉瘤适当的治疗方法。方法 总结184例软组织肉瘤患者的临床资料,分析单纯手术(94例)、手术后加辅助放疗(62例)、手术后加辅助化疗(28例)的长期生存率和影响预后的因素。结果 单纯手术、手术后加辅助放疗和手术后加辅助化疗患者的5年生存率分别为39.4％、48.4％和28.6％。综合治疗是提高患者牛仔率与改善乍活质量的关键。临床分期、病理类型及治疗方法足影响长期生存的重要因素。结论 软组织肉瘤术后辅助放疗可以提高患者5年生存率。     

复发性软组织肉瘤21例临床分析

目的探讨复发性软组织肉瘤的原因及再治疗。方法回顾分析２１例复发性软组织肉瘤临床资料。结果复发后就诊者占７０％（２１／３０）。结论提高对软组织肿瘤的认识，对复发患者应积极开展以手术为主的综合治疗。     

原发性腹膜后软组织肉瘤的诊断与治疗

原发性腹膜后软组织肉瘤是一类临床上比较罕见的局部侵袭性肿瘤，其治疗效果远比四肢软组织肉瘤差。为了提高本病的临床诊断符合率，影像学的检查是必不可少的，尤其是Ｂ超、ＣＴ以及ＭＲＩ的检查，对于确定肿瘤大小、部位、与邻近器官的关系和有无肝脏及腹腔的转移，具有特殊的价值。主张通过开放活检，获取组织学诊断。手术是治疗本病的主要手段，提高本病疗效的关键是手术彻底切除肿瘤。因此，我们主张在明确本病诊断后，尽可能完全或大部分切除肿瘤，对术后复发者，也要争取再次、多次手术切除，并于术后酌情辅加放疗。     

Limb-sparing treatment for soft tissue sarcomas: Influence of prognostic factors

At present, limb-sparing surgery is the most appropriate and acceptable treatment available for sarcomas of the extremities, although the right balance between conservative therapy and maximum efficacy has yet to be found. A better knowledge of prognostic factors may help in planning the appropriate strategy for each case. Eighty patients underwent limb-sparing surgery for limb sarcomas (17 had surgery alone; 19 had neo-adjuvant hyperthermic antiblastic perfusion combined or not with postoperative radiotherapy, and 44 had adjuvant radiotherapy). Univariate and multivariate analyses were made to detect statistically significant differences between subgroups and identify the more significant subset of prognostic factors. Only microscopically positive surgical margins were related to a greater risk of local recurrence, whereas overall survival was compromised by high grade and large tumor size. © 1996 Wiley-Liss, Inc.     

New concepts for the treatment of pediatric nonrhabdomyosarcoma soft tissue sarcomas

Nonrhabdomyosarcoma soft tissue sarcomas form a group of rare tumors with a different biology and clinical behavior. The recently established European Pediatric Soft Tissue Sarcoma Study Group is organizing a new study devoted specifically to these tumors that were formerly treated according to the principles derived from experience with rhabdomyosarcoma, which is a clearly distinct entity. The new study includes two prospective trials, one for synovial sarcoma and the other for adult-type nonrhabdomyosarcoma soft tissue sarcomas. While surgery remains the mainstay of treatment, the role of adjuvant therapy is not yet clear and our understanding of the biology and natural history of nonrhabdomyosarcoma soft tissue sarcomas is still incomplete. This review presents the latest data on nonrhabdomyosarcoma soft tissue sarcoma treatment and outcome, and the rationale behind a risk-adapted treatment program that investigates the role of full-dose ifosfamide–doxorubicin chemotherapy in improving the response rate of patients with unresectable disease, the chances of avoiding adjuvant chemotherapy in low-risk synovial sarcomas, and the possible role of chemotherapy in high-risk adult-type soft tissue sarcomas.     

Intraarterial adriamycin in the treatment of soft tissue sarcomas

Ten patients with extremity sarcomas adriamycin 60 mg/M² into the artery supp supplying the area of tumor. There were minimal local side effects consisting of occasional local erythema or slight transitory pain. Nine of these patients had subsequent surgery, and an average 32.86% histologic tumor necrosis was recorded in the peripherally viable areas of seven patients with residual tumor, compared to a 5.71 % necrosis recorded in the biopsy sections (P value < 0.01).     

腺泡状软组织肉瘤的临床治疗分析

目的探讨腺泡状软组织肉瘤手术切除及辅助放、化疗的临床治疗效果。方法对1993～2006年间收治的腺泡状软组织肉瘤12例回顾性分析。男5例,女7例。年龄11～37岁。肿瘤直径平均5.5cm。结果12例手术后切除缘评价中,达到广泛切除缘者10例,边缘切除缘者2例,术后辅助放疗2例,全组均予辅助化疗。12例手术后复发3例,占25%。有7例发生转移,首诊时转移2例,其中肺转移瘤5例,脑转移瘤2例。转移率58.3%。转移瘤单纯化疗5例中PR3例,NC1例,PD1例,3例PR患者均采用MAI方案。随访时间10个月～10年6个月,12例中7例生存,5例死亡,经过Kaolan-Meire生存率计算,3年生存率81.2%,5年生存率52.8%。结论腺泡状软组织肉瘤外科治疗应以广泛切除术为基本原则,术后辅助放疗可以减少复发,辅助化疗是转移瘤的主要治疗方法。     

Pelvic soft tissue sarcomas

Pelvic soft tissue sarcomas (PSTS) are a rare, heterogeneous group of tumors. They have been usually analyzed with retroperitoneal sarcomas (RPS), but actually have key differences. Due to their unique anatomic location, symptomatic presentation of PSTS may be more common than RPS. Adequate imaging approach is paramount for guiding differential diagnosis, while preoperative biopsy is mandatory, especially when preoperative treatment may be considered as initial approach. The most frequent histologic subtype is leiomyosarcoma, which is different as expected in the retroperitoneum where liposarcoma is the commonest histology. Also solitary fibrous tumor is commonly diagnosed in the pelvis. Surgical approach for PSTS differs from that for RPS mainly due to anatomic relations. Similarly, in the lack of definite evidence from specific trials about neoadjuvant and adjuvant treatments, the anatomic constraints to obtain wide margins in the pelvis as well as the expected functional outcome in case of organ resections should be factored into decision for individualized treatment offer. Vascular and genitourinary involvement are frequent, as well as herniation through pelvic foramina. For these reasons a multidisciplinary surgical team should always be considered. Early referral of these patients to high-volume centers is critical and may impact on survival, given that optimal initial resection is a major predictor of curative treatment. International consensus on PSTS treatment is advocated, similarly to the recent efforts realized for RPS.     

抑癌基因PTEN突变在软组织肉瘤中的研究

Objective  

This study was to investigate whether PTEN mutations play a role in the carcinogenesis of soft tissue sarcomas (STS).     

796例软组织肉瘤分析

目的:了解软组织肉瘤各病种发病情况及相对频率,并调查软组织肉瘤发病趋势。方法:对本院1993年1月至2003年12月所有收治的原发软组织肉瘤796例发病情况进行回顾性分析,从而初步得到各病种发病情况和相对频率,并推测其发病趋势。结果:依据病理分型发病率最高者为恶性纤维组织细胞瘤、滑膜肉瘤、脂肪肉瘤、横纹肌肉瘤等,分别占所收治例数的31.5%,16.8%,16.8%和16.2%。软组织肉瘤可见于各个年龄阶段,可发生于全身任何部位,但各亚型均有各自的特点。结论:软组织肉瘤发病率较低。恶性纤维组织细胞瘤在软组织肉瘤中发病率最高。软组织肉瘤的发病率呈逐年上升趋势。     

Prognostic factors in head and neck soft tissue sarcomas: Analysis of 128 cases

Soft tissue sarcomas make up a heterogenous group of rate malignant tumors originating from mesodermal tissues. Although there have been several improvements in diagnostic methods, staging, and treatment over the past few years, the prognosis of head and neck sarcomas remains worse than those sited at the trunk or extremities. The purpose of this retrospective study was to report the survival results of 128 consecutive patients with soft tissue sarcomas of the head and neck treated from 1953 to 1985. Of the 93 patients submitted to surgical resection, the procedure was considered radical in 67 patients. Of the operated gruop, 46 patients (49.5%) developed recurrence of disease. Thirty-two patients underwent further treatment (surgery, radiotherapy, or chemotherapy), and 14 patients were salvaged, giving the ultimate result of 65.6% disease control rate in the operated group. The univariate survival analysis showed no statistical difference (P > 0.05) according to age, race, sex, and site or histologic type of the tumor. Radicality of surgery was an important prognostic factor affecting survival (P = 0.0014 for disease-free interval and P = 0.0183 for overall survival). The multivariate analysis showed that the radicality of surgery and tumor histology were independent prognostic factors affecting recurrence. The same variables and age group were related to the risk of death. Every effort must be made to make an early diagnosis and a radical surgical resection of these tumors must be tried (except for embryonal rhabdomyosarcoma), because it offers the best chance for cure. © 1994 Wiley-Liss, Inc.     

Centralised treatment of soft tissue sarcomas in adults

The clinical research developed in specialised centres and oncologic cooperative groups has permitted various scientific societies to collect recommendations used in the treatment of soft tissue sarcomas (STS) and incorporate them into clinical practice guidelines (CPG). Some studies have been conducted in diverse healthcare ambits to assess the influence of CPG. This revision of the medical literature analyses the impact that healthcare management -centralised or otherwise- and clinical practice in conformity with CPG have on the clinical outcome variables of STS. Eight CPG have been identified, as well as 12 conformity studies or audits. These conformity studies and audits demonstrate that the grade of adaptation of medical interventions with CPG, medical healthcare in reference centres and procedures of referrals to these centres, as well as the process of organising healthcare teams into Sarcoma Committees, have a significant influence on clinical outcome. We can conclude that excellent healthcare of STS implies the adaptation of healthcare practice to CPG, the existence of Reference Centres guided by Sarcoma Committees, and the observance of strict referral procedures within the Healthcare Area.