腹部恶性纤维组织细胞瘤47例临床和预后分析

目的探讨腹部恶性纤维组织细胞瘤(MHF)的临床病理特点、治疗策略及预后相关因素。方法回顾性分析1970年1月至2000年1月间天津医科大学附属肿瘤医院47例腹部恶性纤维组织细胞瘤患者手术切除治疗情况。所有患者均经手术病理证实,病变单一。结果术后随访中共有32例患者出现复发、转移,术后单纯局部复发13例(29.5%),出现肺及胸膜转移7例(15.9%),肝转移4例(9.0%),骨转移6例(13.6%),肾脏转移2例(4.5%),复发 转移5例(11.4%)。术后1,3,5年无瘤生存率分别为65.9%、40.9%和29.5%,累计生存率分别为70.5%、52.3%和31.8%,中位生存期为18个月。影响预后的主要因素为肿瘤发生的部位、治疗方式、病理类型、肿瘤的局部复发等。以手术为主的综合治疗较单纯手术及放化疗预后好,术后辅以放疗可降低局部复发率,尤其对那些切端阳性患者。结论腹部MHF侵袭性强,复发率高,病理分级差,以手术切除为主辅以放疗有助于提高患者的远期生存率。

Analysis of the surgical outcome and prognostic factors for malignant fibrous histiocytoma in the abdominal cavity

Objective To assess the therapeutic strategies and prognostic factors that could influence clinical outcome of malignant fibrous histiocytoma(MFH) in the abdominal cavity.Methods Forty-seven patients with malignant fibrous histiocytoma(MFH) in the abdominal cavity between January 1970 and January 2000 admitted to this hospital were retrospectively analyzed regarding prognostic factors of the disease.All patients had localized disease and had surgery as the primary treatment modality with or without radiotherapy and/or chemotherapy.The relationship between clinicopathological findings and surgical outcomes was examined.Results The recurrence of MFH appeared in 32 patients,13(29.5%) of them had only local recurrence and 19 had distant metastasis.Seven(15.9%) of them had lung metastasis,4(9.0%) had liver metastasis,6(13.6%)had bone metastasis and 2(4.5%)had kidney metastasis.The 1-year,3-year and 5-year disease-free survival rates(%) of the patients were 65.9%,40.9% and 29.5%,and the 1-year,3-year and 5-year cumulative survival rates(%) were 70.5%,52.3% and 31.8%.The significant independent factors related to the prognosis were the location of the tumor,histological grade,local recurrence after primary surgery,adjuvant radiotherapy,etc.Complete surgical resection at the time of primary tumor presentation was likely to afford the best chance for MFH.Combined therapy with surgery as the main measure resulted in better prognosis than surgery,radiotherapy or chemotherapy alone did.Radiotherapy after operation could reduce local recurrence rate,especially in cases with positive surgical margins after wide complete gross excision.The role of postoperative adjuvant chemotherapy remained to be investigated.Conclusions Malignant fibrous histiocytoma(MFH) in the abdominal cavity is a rare tumor with high biological aggressiveness and high metastasis potential.Surgical resection has generally been accepted as the treatment of first choice for MFH.At the same time,radiation therapy in combination with surgery can result in good local control,particularly for high-grade lesions.Postoperative radiation therapy is essential in cases of positive surgical margins after wide complete gross excision.