CAJ | 학술논문

目的探讨广泛切除术后进行放、化疗与单纯化疗对Ⅱ、Ⅲ期(AJCC分期)肢体软组织肉瘤患者预后的影响.方法回顾性分析2007年7月1日至2012年12月31日行广泛切除手术的81例AJCC分期Ⅱ、Ⅲ期的肢体软组织肉瘤患者的病例资料,放、化疗组59例,单纯化疗组22例.通过单因素及多因素分析影响无病生存时间和总生存时间的临床因素.结果 81例患者均得到随访.放、化疗组中位随访时间为29个月(2～66个月),单纯化疗组为19个月(2～59个月).放、化疗组局部复发13例(22％),远处转移14例(23.7％),死亡8例(13.6％);单纯化疗组局部复发5例(22.7％),远处转移10例(45.5％),死亡4例(18.2％).单因素分析显示中位无病生存时间与治疗方式(放、化疗组44个月,单纯化疗组14个月,x2=5.87,P=0.015)和AJCC分期(Ⅱ期42个月,Ⅲ期24个月,x2=4.404,P=0.036)相关.多因素分析显示治疗方式是影响无病生存时间的独立因素(P=0.02,OR=0.44,95％ CI=0.221～0.877).单因素分析显示不同治疗方式与中位总生存时间无关(放、化疗组57个月,单纯化疗组43个月,x2=1.147,P=0.284),中位总生存时间与肿瘤大小(≤5 cm者60个月,＞5 cm者45个月,x2=4.478,P=0.034)、组织学分级(G2级者52个月,G3级者50个月,x2=4.325,P=0.038)和AJCC分期(Ⅱ期61个月,Ⅲ期39个月,x2=9.935,P=0.002)相关.多因素分析显示未发现影响中位总生存时间的临床因素.结论对于经过广泛切除手术的Ⅱ、Ⅲ期肢体软组织肉瘤患者,放、化疗较单纯化疗可延长患者中位无病生存时间.
목적 탐토엄범절제술후진행방、화료여단순화료대Ⅱ、Ⅲ기(AJCC분기)지체연조직육류환자예후적영향.방법 회고성분석2007년7월1일지2012년12월31일행엄범절제수술적81례AJCC분기Ⅱ、Ⅲ기적지체연조직육류환자적병례자료,방、화료조59례,단순화료조22례.통과단인소급다인소분석영향무병생존시간화총생존시간적림상인소.결과 81례환자균득도수방.방、화료조중위수방시간위29개월(2～66개월),단순화료조위19개월(2～59개월).방、화료조국부복발13례(22％),원처전이14례(23.7％),사망8례(13.6％);단순화료조국부복발5례(22.7％),원처전이10례(45.5％),사망4례(18.2％).단인소분석현시중위무병생존시간여치료방식(방、화료조44개월,단순화료조14개월,x2=5.87,P=0.015)화AJCC분기(Ⅱ기42개월,Ⅲ기24개월,x2=4.404,P=0.036)상관.다인소분석현시치료방식시영향무병생존시간적독립인소(P=0.02,OR=0.44,95％ CI=0.221～0.877).단인소분석현시불동치료방식여중위총생존시간무관(방、화료조57개월,단순화료조43개월,x2=1.147,P=0.284),중위총생존시간여종류대소(≤5 cm자60개월,＞5 cm자45개월,x2=4.478,P=0.034)、조직학분급(G2급자52개월,G3급자50개월,x2=4.325,P=0.038)화AJCC분기(Ⅱ기61개월,Ⅲ기39개월,x2=9.935,P=0.002)상관.다인소분석현시미발현영향중위총생존시간적림상인소.결론 대우경과엄범절제수술적Ⅱ、Ⅲ기지체연조직육류환자,방、화료교단순화료가연장환자중위무병생존시간.
Objective To compare the therapeutic effect of chemotherapy combined with adjuvant radiation therapy and chemotherapy alone in the treatment of soft tissue sarcoma of the extremity after wide excision.Methods Between June 2007 and December 2012,a total of 81 patients with AJCC stage Ⅱ or stage Ⅲ soft tissue sarcoma of the extremity after wide excision were analyzed retrospectively.There were 59 patients in chemotherapy combined with adjuvant radiation therapy (CRT) group and 22 patients in chemotherapy alone (CA) group.Univariate and multivariate analyses were performed to determine clinicopathologic factors associated with disease-free survival (DFS) and overall survival (OS).Results All of the 81 patients were followed.The CRT group was followed up with a median time of 29 months,ranging from 2 to 66 months,while the CA group was followed up with a median time of 19 months,ranging 2 to 59 months.There were 13 cases (22％) of local recurrence,14 cases (23.7％) of distant metastasis and 8 (13.6％) cases of death in the CRT group.There were 5 cases (22.7％) of local recurrence,10 cases (45.5％) of distant metastasis and 4 cases (18.2％) of death in the CA group.In the univariate analysis,the median DFS was associated with the treatment after surgery (CRT group 44 months while CA group 14 months,x2=5.87,P=0.015) and AJCC stages (stage Ⅱ 42 months while stage Ⅲ 24 months,x2=4.404,P=0.036).The multivariate analysis demonstrated a favorable impact of treatment after surgery on DFS (P=0.02,OR=0.44,95％CI=0.221-0.877).In the univariate analysis,there was no significant difference between the two groups of different treatments in the median OS,which was associate with tumor sizes (≤ 5 cm on 60 months while ＞ 5 cm on 45 months,x2=4.478,P=0.034)、histological grades (G2 on 52 months while G3 on 50 months,x2=4.325,P=0.038) and AJCC stages (stage Ⅱ on 61 months while stage Ⅲ on 39 months,x2=9.935,P=0.002).In the multivariate analysis,there were no clinical factors to demonstrate a favorable impact on OS.Conclusion For AJCC stage Ⅱ or stage Ⅲ soft tissue sarcoma of the extremity after wide excision,chemotherapy combined with adjuvant radiation therapy could achieve longer DFS than chemotherapy alone.