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原发性腹膜后平滑肌肉瘤局部复发和预后分析

Predictors of local recurrence and survival in primary retroperitoneal leiomyosarcoma

摘要:

目的 分析原发性腹膜后平滑肌肉瘤患者的临床病理资料,探讨影响其术后局部复发和患者预后的因素.方法 收集2006年8月至2012年4月收治的46例原发性腹膜后平滑肌肉瘤完整切除术后患者的临床病理和随访资料,男性9例,女性37例,年龄30 ~ 79岁(中位年龄49岁).采用Kaplan-Meier法分析肿瘤局部控制率和疾病特异生存率,单因素和多因素分析采用Cox回归法.结果 46例患者肿瘤最大径5 ~ 36 cm,其中>10 cm者29例(63.1%).完整切除术后3、5年局部控制率分别为47%和30%.多因素分析结果表明,法国联邦国家癌症中心(FNCLCC)分级(RR =3.10,95% CI:1.59 ~6.04)、性别(RR =5.30,95% CI:1.64~ 17.13)和失血量(RR =3.12,95% CI:1.28 ~7.60)是影响局部复发的独立危险因素(P<0.05).完整切除术后5年无病生存率为26%,5年疾病特异生存率为48%.多因素分析表明FNCLCC分级是影响疾病特异生存的独立危险因素(RR=2.01,95% CI:1.16 ~ 3.49,P=0.013).结论 性别、FNCLCC分级和失血量是影响原发性腹膜后平滑肌肉瘤局部复发的独立危险因素;FNCLCC分级可预测疾病特异生存情况.

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abstracts:

Objective To investigate the predictors of local recurrence and survival in primary retroperitoneal leiomyosarcoma (PRLS).Methods A retrospective analysis was conducted on 46 cases of PRLS between August 2006 and April 2012.There were 9 male and 37 female patients,and they were 30-79 year old (median 49 year old).Kaplan-Meier estimations and Cox regression analyses were performed.Results The tumor size were 5-36 cm,and 29 cases (63.1%) of this group was more than 10 cm.Local 3-and 5-year control rates after complete resection were 47% and 30%.FNCLCC (Fédération Nationale des Centres de Lutte Contre le Cancer) grading (RR =3.10,95% CI:1.59-6.04),gender (RR =5.30,95 % CI:1.64-17.13) and blood loss (RR =3.12,95 % CI:1.28-7.60) were independent prognostic factor of local recurrence in multivariable analysis (P < 0.05).The 5-year disease-free survival rates after complete resection of PRLS was 26% ; and the 5-year disease-specific survival (DSS) rates after complete resection was 48%.The median DSS was 60 months in negative margin of resection and 50 months in positive margin.However,by multivariate analysis,only FNCLCC grading was significant independent predictors of DSS (RR =2.01,95 % CI:1.16-3.49,P =0.013).Conclusions Gender,FNCLCC grading and blood loss were independent prognostic factor of local recurrence.The disease-specific survival in PRLS varied significantly according to FNCLCC grading.

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