影响黏液样脂肪肉瘤和黏液纤维肉瘤切除术后预后的因素（开放获取）

Factors impacting prognosis after resection of myxoliposarcoma and myxofibrosarcoma

摘要:

[目的] 探讨影响黏液样脂肪肉瘤和黏液纤维肉切除术后预后的因素。[方法] 回顾性分析 2020 年 1 月—2023 年 1 月本院手术治疗黏液样脂肪肉瘤或黏液纤维肉瘤的 22 例患者的临床资料，通过单因素比较和单变量 Cox 风险比例回归分析影响患者预后的因素。使用 Kaplan–Meier 法计算预测生存率，绘制生存曲线，生存差异行 Log rank 检验。[结果] 22 例患者中，14 例（64%）接受了根治性切除，另外 8 例（36%）接受了广泛切除。所有患者随访 24~48 个月。4 例（18%）于术后 3~ 24 个月死亡，平均为（13.8±4.4）个月。单因素分析表明：浸润生长者浅表生长的比率显著高于非浸润生长组（P＜0.05）。按生长方式分层比较，浸润性生长的实际疾病特异性生存期 （disease specific survival, DSS）、实际局部无复发生存期 （local failure free survival, LFFS） 和实际远处无转移生存期 （distant failure free survival, DFFS） 均显著短于非浸润性生长 （P＜0.05），按外科边界分层比较，切缘阴性者的实际 DSS、LFFS 和 DFFS 均显著长于切缘阳性者 （P＜0.05）。单因素 Cox 风险比例回归表明，生长方式 （浸润性生长） 的外科边界 （切缘阳性） 是影响 DSS、LFFS 和 DFFS 独立危险因素 （P＜0.05）。Kaplan-Meier 生存分析法预测 2 年 DSS、LFFS 和 DFFS 生存率分别为 83%（95%CI: 72~94）、83%（95%CI: 72~94）和 64%（95%CI: 50~79）。Log rank 检验表明：非浸润生长者的预测 DSS [(46.3±1.1) 个月 vs (26.3±4.2) 个月, P=0.001]，预测 LFFS [(45.4±1.8) 个月 vs (24.6±4.6) 个月, P=0.001] 和预测 DFFS 均显著长于浸润生长者 [(43.6±1.7) 个月 vs (22.8±3.8) 个月, P＜0.001]。[结论]与非浸润性生长相比，浸润性生长的黏液样脂肪肉瘤和黏液纤维肉瘤的患者预后更差。浸润性生长方式和外科切缘阳性是影响患者预后的独立危险因素。

Abstract:

[Objective] To explore the factors impacting prognosis after resection of myxoliposarcoma and myxofibrosarcoma. [Meth ods] A retrospective study was conducted on 22 patients who had myxoliposarcoma or myxofibrosarcoma resected surgically in our hospital from January 2020 to January 2023. Clinical data were collected, and the factors that might impacting the prognosis of patients were analyzed by univariate comparison and univariate Cox proportional hazards regression. In addition, the predicted survival rate was calculated using the Kaplan-Meier method, the survival curve was plotted, and the survival difference was tested by Log rank. [Results] Among the 22 patients, 14 cases (64%) underwent radical resection, and another 8 cases (36%) underwent extensive resection. All patients were followed up for 24 to 48 months. Four cases (18%) died 3 to 24 months after the operation, with an average of (13.8±4.4) months. Regarding univariate comparison, the invasive growth subgroup had significantly higher ratio of superficial position than the non-invasiv growth subgroup (P＜ 0.05). As results of stratified comparison by growth pattern, the invasive growth subgroup was significantly shorter than the non-invasive growth subgroup in terms of actual disease-specific survival (DSS), actual local failure-free survival (LFFS) and the actual distant failurefree survival (DFFS) period (P＜0.05). In term of stratified comparison by surgical boundaries, the negative surgical margins subgroup were significantly longer than the positive surgical margins subgroup in actual DSS, LFFS and DFFS period (P＜0.05). As results of univariate Cox proportional hazards regression, the surgical margin (positive margin) and the growth pattern (invasive growth) was the independent risk factors shortening DSS, LFFS and DFFS period (P＜0.05). The Kaplan-Meier survival analysis predicted the 2-year survival rates in terms of DSS, LFFS and DFFS as 83% (95%CI: 72~94), 83% (95%CI: 72~94) and 64% (95%CI: 50~79), respectively. The Log rank test indicated that: the non-invasive growth subgroup was significantly longer than the invasive growth subgroup in the predicted DSS [(46.3±1.1) months vs (26.3±4.2) months, P=0.001], the LFFS [(45.4±1.8) months vs (24.6±4.6) months, P=0.001] and the DFFS [(43.6±1.7) months vs (22.8±3.8) months, P＜0.001]. [Conclusion] Compared with the non-invasive growth pattern, the invasive- growth myxoliposarcoma and myxofibrosarcoma have poorer prognosis. The invasive-growth pattern and positive surgical margins after resection are independent risk factors impacting the clinical prognosis.