腹膜后软组织肉瘤术后复发分析

目的 探讨影响腹膜后软组织肉瘤手术后局部复发的因素。方法 对1980年1月至2005年12月间施行手术的77例原发性腹膜后软组织肉瘤患者进行回顾性分析。结果术后局部复发57例,总复发率74％,手术到复发平均时间14．8个月（3．2～99,6个月）。术后远处转移3例。截至随访结束,共32例患者死亡,其中27例死于肿瘤。术后中位生存期为42,5个月,5年和10年总生存率为61,7％和43．9％,5年和10年无复发生存率为22,7％和16,8％。单因素分析显示,术中肿瘤切除不净（P：0,0008）、高分级肿瘤（P：0．018）与术后肿瘤局部复发率升高密切相关;而在多因素分析中,只有肿瘤完整切除（P=0．001）为复发率降低的独立预后因素。结论术中完整切除肿瘤,保证手术切缘阴性是降低术后肿瘤局部复发率最重要的影响因素,高分级肿瘤患者的术后局部复发机率显著增大。

Factors for recurrence of primary retroperitoneal sarcoma: analysis of 77 cases

OBJECTIVE: To explore the factors influencing the recurrence of retroperitoneal sarcoma. METHODS: The clinical data of 77 patients with primary retroperitoneal sarcoma who were treated with surgery between Jan 1980 and Dec 2005 and followed up for 45.7 months (3.6 - 180.4 months), 36 males and 41 females, aged 49 (24 - 75). RESULTS: 57 cases developed local recurrence and 3 had metastases after surgery. The overall recurrence rate was 74%. The median time between initial surgery and recurrence was 14.8 months (3.2 - 99.6 months). 27 patients died of sarcoma and 5 die of other reasons. The median survival time was 42.5 months (3.6 - 180.4 months). The overall 5-year and 10-year survival rates were 61.7% and 43.9% respectively, and the 5-year and 10-year relapse-free survival rates were 22.7% and 16.8% respectively. Univariate analysis showed that incomplete tumor resection and high-grade tumor were associated with the increased local recurrence rate (P = 0.0008 and P = 0.018). Cox multivariate analysis showed that the only factor found to decrease the risk of local recurrence was complete tumor resection (P = 0.001). CONCLUSION: Complete surgical resection at the time of primary tumor presentation affords the best chance for local control. Patients with high-grade tumor should on the alert for local relapse after surgery.