单中心高度恶性软组织肉瘤的诊疗经验

背景与目的：高度恶性软组织肉瘤是一类转移率高、预后差的恶性肿瘤。该研究总结单中心高度恶性软组织肉瘤的治疗经验，以指导制定这类肿瘤患者的个体化治疗方案。方法：对2000年7月—2014年7月在北京大学人民医院骨与软组织治疗中心接受手术及辅助治疗的473例高度恶性软组织肉瘤患者的临床资料进行回顾性分析，随访这些患者复发、转移及生存情况，分析影响预后的因素。结果：共有400例（84.6%）患者接受了保肢治疗。103例患者出现局部复发，148例患者出现肺、骨等远处转移，419例（88.6%）患者接受广泛性切除。370例患者接受术后化疗，153例患者接受局部放疗。平均随访时间为46.9个月（8.0~127.0个月）。随访期间114例患者死亡。3、5及10年总生存率分别为82.6%、69.0%及58.7%。统计学分析显示，肿瘤的组织学类型、辅助化疗及转移情况是影响患者预后的危险因素。结论：对高风险的肿瘤患者应进行积极的辅助治疗，包括通过化疗降低转移风险和局部放疗降低复发率，以期提高这些患者的生存率。

Outcomes and prognostic factors of high-grade soft tissue sarcoma: experience at a single institution

Background and purpose: High-grade soft tissue sarcomas are a series of life-threatening malignant tumors. This study aimed to share our ten-year clinical experience in treating high-grade soft tissue sarcoma to identify prognostic factors and probe further into the appropriate therapeutic strategies. Methods: We retrospectively reviewed the clinical features and outcome of 473 patients with high-grade soft tissue sarcoma treated at Musculoskeletal Tumor Center of Peking University People’s Hospital from July 2000 to July 2014. The patients were followed-up and their clinical characteristics were analyzed. Results: Four hundred patients received limb salvages. One hundred and three patients developed local recurrence while 148 patients had evidence of distal metastases in lung or other bones. 419 (88.58%) patients received tumor resection with wide margin. Three hundred and seventy patients had adjuvant chemotherapies while 153 patients had radiation. The mean follow-up time was 46.9 months (ranging from 8 to 127 months). The 3-year, 5-year and 10-year overall survival rates were 82.6%, 69.0% and 58.7% respectively. The statistical analysis showed histologic subtype, chemotherapy and distant metastasis had significant relevance to prognosis. Conclusion: All the patients with high risk should receive adjuvant treatments, which have been demonstrated to contribute to overall survival improvements. Radiotherapy is helpful with local control, while chemotherapy is conducive to reduce metastatic risk.