普通软骨肉瘤复发后的恶性进级和去分化演变

目的探讨普通软骨肉瘤复发后出现病理级别改变及去分化病例的治疗方法及预后。方法1997年4月至2005年4月,收治初诊为普通软骨肉瘤的患者91例,按是否局部复发分为复发软骨肉瘤和无复发软骨肉瘤。复发组36例,男21例,女15例;年龄13～65岁,平均40.6岁。无复发组55例,男37例,女18例;年龄15～72岁,平均43.2岁。根据Enneking分期确定外科治疗边界,复查所有复发病例的病理切片并分级。结果复发组共行53例次手术,病灶内切除21例次,边缘切除15例次,广泛切除17例次。无复发组12例病灶内切除,13例边缘切除,30例广泛切除。复发组随访33例,其中16例死于肿瘤转移和复发,5例带瘤存活,12例无瘤存活,五年生存率46.91%;无复发组随访47例,其中7例死于肿瘤转移,4例带瘤存活,36例无瘤存活,五年生存率76.81%。复发组中15例发生病理级别的改变,其中8例出现去分化改变,7例发生恶性进级。7例发生恶性进级的患者中,3例无瘤生存,2例带瘤生存,2例死亡。8例发生去分化患者中,2例带瘤存活,6例全部死亡。结论普通软骨肉瘤复发后可以出现恶性病理进级和去分化改变,初次手术时应尽量做到广泛切除,以减少复发、提高生存率。

Tumor progression and dedifferentiation of recurrent chondrosarcoma

Objective The current study is a review of patients with tumor progression and dedifferentiation of recurrent chondrosarcoma,and to discuss the treatment methods and prognosis.Methods Between April 1997 and April 2005,91 patients with ordinary chondrosarcoma at initial diagnosis had been treated in our institute.Among them,36 patients had local recurrence and 55 patients had no local recurrence.The records of patient and operation,the image and pathological files,the follow-up information were collected.The surgical margin was decided according to Enneking system,and the pathological results of the recurrent cases were reviewed by an experienced pathological consultant.Results Fifty-three cases of operations in local recurrent group were held in our institute,21 cases had intralesional margin,15 cases had marginal margin and 17 cases had wide margin.In no local recurrent group,12 patients had intralesional margin,13 patients had marginal margin,and 30 patients had wide margin.In local recurrent group,33 patients had regular follow-up,16 patients died of disease,5 patients were alive with disease,and 12 patients had no evidence of disease.The five year survival rate was 46.91%.In no local recurrent group,47 patients had regular follow-up,7 patients died of disease,4 patients were alive with disease,and 36 patients had no evidence of disease.The five year survival rate was 76.81%.In local recurrent group,seven patients had tumor progression(2 patients die of disease,2 patients alive with disease,and 3 patients no evidence of disease) and eight patients had dedifferentiation change(6 patients die of disease,2 patients alive with disease).Conclusion Because tumor progression and dedifferentiated change can be seen in recurrent chondrosarcoma,wide excision should be done in ordinary type chondrosarcoma for better prognosis,especially for the first time.