109例成人软组织肉瘤化疗的疗效分析

背景与目的:成人软组织肉瘤(soft tissue sarcoma,STS)发病率低,化疗效果不肯定.本研究通过分析成人软组织肉瘤病例的临床特征,探讨化疗在成人软组织肉瘤综合治疗中的意义.方法:回顾性分析2000年1月至2005年12月在中山大学肿瘤防治中心诊断为软组织肉瘤,并接受化疗的109例患者的临床资料和化疗情况,统计各一线化疗方案的有效率及患者的生存资料.结果:109例患者中有66例行姑息化疗,40例行辅助化疗,3例行新辅助化疗.姑息化疗患者一线化疗方案的总有效率为22.7%,中位生存期16.9个月,1年和2年生存率分别为63.6%和33.3%,中位无进展生存期为3.4个月.仅发生肺转移的患者中位生存期为25.1个月,仅发生肝转移的患者中位生存期为11.8个月,两者比较差异有统计学意义(P＜0.05).MAID方案是最常用的一线化疗方案,其次是CYVADIC方案,有效率(完全缓解 部分缓解)分别为28.0%和22.2%.确诊后半年内发生转移的患者比半年后转移的患者中位生存期短(11.8个月vs.42.9个月),两者之间差异有统计学意义(P=0.04).结论:MAID和CYVADIC均为有效的化疗方案,既往使用过常规剂量的阿霉素±异环磷酰胺后进展的患者仍可能从大剂量异环磷酰胺化疗中获益.肝转移患者比肺转移患者对化疗更不敏感,确诊后半年内出现转移的患者预后较确诊半年后转移者差.

Responses of 109 adult soft tissue sarcoma patients to chemotherapy

BACKGROUND & OBJECTIVE: The response of adult soft tissue sarcoma (STS) to chemotherapy is uncertain. This study was to evaluate the role of chemotherapy in treating adult soft tissue sarcoma. METHODS: Clinical data of 109 adult soft tissue sarcoma patients, treated with chemotherapy at Cancer Center of Sun Yat-sen University from Jan. 2000 to Dec. 2005, were analyzed. RESULTS: Of the 109 patients, 66 received palliative chemotherapy, 40 received adjuvant chemotherapy, and 3 received neoadjuvant chemotherapy. The overall response rate for first line chemotherapy was 22.7%. The median survival was 16.9 months. The 1-and 2-year survival rates were 63.6% and 33.3%. The patients with lung metastasis had a significantly longer median survival than those with liver metastasis did (25.1 months vs. 11.8 months, P<0.05). MAID and CYVADIC were the most commonly used first-line chemotherapy regimens; the response rates were 28.0% and 22.2%, respectively. When anthracycline and/or standard dose ifosfamide failed, the patients could still benefit from high dose ifosfamide (14.0 g/m(2)). The median survival was significantly shorter in the patients who got metastasis within 6 months after diagnosis than in those that got metastasis more than 6 months after diagnosis (11.8 months vs. 42.9 months, P=0.04). Of the 40 patients who received adjuvant chemotherapy, 16 developed progression during follow-up: 10 had relapse and 6 had distant metastasis. CONCLUSIONS: MAID and CYVADIC are two effective chemotherapy regimens for adult soft tissue sarcoma. We recommend to take a high dose ifosfamide when anthracycline and/or standard dose ifosfamide failed. The patients with liver metastasis are more resistant to chemotherapy than those with lung metastasis. Developing metastasis within 6 months after diagnosis is a poor prognostic factor.