CAJ | 학술논문

目的分析侵袭性纤维瘤病的临床特征及预后因素,为临床治疗提供依据.方法回顾分析本院1983-2009年治疗的142例侵袭性纤维瘤病患者的临床资料,观察临床特点及治疗方式对预后影响.采用Logrank单因素分析及Cox多因素回归分析评估可能影响局部预后的危险因素.结果随访率为93.7%,随访满5、10者分别为63例、6例.本组病例男女比例为1∶1.8,18～35岁女性为高发人群(25.4%).病变部位发生于躯干(55.6%)及四肢(31.7%)多见.5、10年局部复发率分别为24.4%、31.1%,生存率均为99.3%.单因素分析发现肿瘤大小(χ2=4.37,P=0.037)和切缘情况(χ2=12.36,P=0.002)为肿瘤复发的危险因素.多因素分析发现切缘情况为独立的复发危险因素(RR=2.129;χ2=9.47,P=0.002),放疗为侵袭性纤维瘤病的保护因素(RR=0.360;χ2=4.95,P=0.026).放疗后切缘阳性患者10年局部复发率从70.1%降至20.7%(χ2=4.22,P=0.040);而切缘阴性患者从19.8%降至10.4%(χ2=0.90,P=0.344).结论根治性切除为侵袭性纤维瘤病的首选治疗,术后放疗可以降低切缘阳性患者的局部复发率,但对切缘阴性患者的意义尚需大样本临床研究证实.
목적 분석침습성섬유류병적림상특정급예후인소,위림상치료제공의거.방법 회고분석본원1983-2009년치료적142례침습성섬유류병환자적림상자료,관찰림상특점급치료방식대예후영향.채용Logrank단인소분석급Cox다인소회귀분석평고가능영향국부예후적위험인소.결과 수방솔위93.7%,수방만5、10자분별위63례、6례.본조병례남녀비례위1∶1.8,18～35세녀성위고발인군(25.4%).병변부위발생우구간(55.6%)급사지(31.7%)다견.5、10년국부복발솔분별위24.4%、31.1%,생존솔균위99.3%.단인소분석발현종류대소(χ2=4.37,P=0.037)화절연정황(χ2=12.36,P=0.002)위종류복발적위험인소.다인소분석발현절연정황위독립적복발위험인소(RR=2.129;χ2=9.47,P=0.002),방료위침습성섬유류병적보호인소(RR=0.360;χ2=4.95,P=0.026).방료후절연양성환자10년국부복발솔종70.1%강지20.7%(χ2=4.22,P=0.040);이절연음성환자종19.8%강지10.4%(χ2=0.90,P=0.344).결론 근치성절제위침습성섬유류병적수선치료,술후방료가이강저절연양성환자적국부복발솔,단대절연음성환자적의의상수대양본림상연구증실.
Objective Aggressive fibromatosis is a rare kind of soft tissue tumor and was evaluated by few large studies. This study was to evaluate the clinical characteristics and identify the prognostic factors of this disease. Methods One hundred and forty-two patients with aggressive fibromatosis treated from January 1983 to August 2009 in Tianjin Medical University Cancer Hospital were retrospectively reviewed.The prognostic value of clinical and treatment factors was analyzed. Univariate analysis was performed with Log-rank test and Multivariate analysis was performed with Cox regression model. Results The follow-up rate is 93.7% and the median follow up time was 54 months (range,6 -208 months). Sixty-three patients had a minimum follow up time of 5 years and 6 patients had a minimum follow up time of 10 years. The male/female ratio was 1/1.84. The disease was most popular in women aged from 18 to 35 years old. The disease frequently occurred in the trunk (55.6%) and extremity (31.7%). All patients received surgery,and 46 received radiotherapy. The 5-year and 10-year local recurrence rates were 24. 4% and 31.1%,respectively. The 5-year and 10-year overall survival rates were both 99. 3%. Univariate analysis revealed that factors correlated with local recurrence were tumor size ( χ2 = 4. 37, P = 0. 037 ) and margin status (χ2 = 12. 36,P =0. 002). Multivariate analysis revealed that margin status was an independent risk factor (RR = 2. 219; χ2 = 9. 47,P = 0. 002) and radiotherapy was an independent protective factor ( RR = 0. 360;χ2 = 4. 95, P = 0. 026 ) for disease recurrence. When radiotherapy was delivered, the 10-year local recurrence rate decreased from 70. 1% to 20. 7% in patients with positive margin ( χ2 = 4. 22, P = 0. 040 )and decreased from 19.8% to 10.4% (χ2= 0.90, P= 0.344) in patients with negative margin.Conclusions Radical resection is the mainstay of treatment for aggressive fibromatosis. Postoperative radiotherapy can reduce the recurrent rate for patients with positive margin. In patients with negative margin,the role of radiotherapy should to be further evaluated in large clinical trials.