胸壁软骨肉瘤治疗及预后的多因素分析

Multivariate analysis of treatment and prognosis in chest wall chondrosarcoma patients

关键词:  软骨肉瘤  胸壁  预后

Key words:  chondrosarcoma  chest wall  prognosis

摘要:

目的　探讨胸壁软骨肉瘤的治疗及预后情况，筛选可能影响软骨肉瘤预后的因素。　方法　收集1986-2014年大连医科大学附属第一医院手术治疗并有完整随访资料的22例胸壁软骨肉瘤患者的病历资料进行回顾性分析。采用Kaplan-Meier方法对患者5年生存率进行单因素分析，并进行Log-rank检验，再将单因素分析有统计学意义的因素采用Cox回归模型进行多因素分析，筛选影响预后的独立因素。　结果　本组患者均切除病灶，部分行胸壁重建术，中位随访时间88.5个月（2～310个月）。患者无手术死亡，术后病理均证实为软骨肉瘤，15例来源于肋骨，5例来源于胸骨，2例来源于胸骨及肋骨。行胸壁重建后，胸部外表形态近于正常。病理分级、年龄、切缘阴性及肿瘤大小是影响预后的独立因素。　结论　早期发现，尽可能根治切除，尽可能获得较大无瘤边缘以减少局部复发仍是胸壁软骨肉瘤的主要治疗策略。

Abstract:

Objective　 To study clinical treatment and prognosis of primary chest wall chondrosarcoma by multivariate analysis of clinical data as well as surgical treatment and follow-up results and to screen for possible prognostic factors.　Methods　 Totally 22 patients with primary chest wall chondrosarcoma received surgery and complete follow-up from March 1986 to December 2014 in our hospital. Univariate analysis was performed using Kaplan-Meier method on survival rate, followed by Log-rank test. Multivariate analysis was then performed on the significant indexes detected by univariate analysis using Cox regression models, to filter out the independent prognostic factors.　Results 　All of the patients received excision of the lesion and some had reconstruction of chest wall. The median follow-up time was 88.5 months (2-310 months). There was no intra-operative death. All cases were confirmed for chondrosarcoma by postoperative histology. Fifteen of them were originated from rib, five from stern, and two from rib and stern. After reconstruction, the shape of chest wall was close to normal. Pathological grade, age, stump-negativity and tumor size were independent prognostic factors.　Conclusion　 Currently, early detection and radical excision with as large tumor-free margins as possible to reduce local recurrence are still the main treatment options for chest wall chondrosarcoma.