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目的探讨经动脉新辅助化疗治疗软组织恶性纤维组织细胞瘤(malignant fibrous histiocytoma,MFH)的疗效,并分析软组织MFH预后相关因素。方法回顾性分析1999年9月至2011年12月,我院收治的101例软组织MFH患者的临床资料。所有病例均经化疗泵动脉给予顺铂、阿霉素、去甲斑蝥素化疗。根据患者就诊时是否进行过治疗的情况分原发肿瘤组和复发肿瘤组两组,分别为44例(A组)和57例(B组),每组再根据治疗方式为新辅助化疗结合手术或单纯新辅助化疗各细分为2组。A组中手术切除的15例,为A1组;未行手术治疗的29例,为A2组。B组中行肿瘤手术的45例,为B1组;未行手术的12例,为B2组。采用肿瘤坏死率来判断手术患者化疗的疗效。观察5年总体生存率、5年无瘤生存率、复发及转移情况,并对患者年龄、性别、肿瘤大小、肿瘤部位、肿瘤浸润组织深度、肿瘤是否复发、病理类型、组织学分级及化疗后组织反应等9项影响预后的因素进行统计学分析。结果本组101例随访3~145个月,平均60个月。(1)本研究共23例肿瘤切除标本进行了肿瘤坏死率分析,A1组5例肿瘤切除标本中肿瘤坏死率75.0%,4例(80.0%)化疗反应好,B1组18例肿瘤坏死率73.8%,14例(77.8%)化疗反应好,两组肿瘤坏死率及化疗反应好者比率相比,差异无统计学意义(P>0.05)。(2)本组总体生存率65.3%,原发组5年无瘤生存率和总体生存率分别为70.5%和75.0%,复发组5年无瘤生存率和总体生存率分别为56.1%和57.9%,两组的总体生存率相比,差异有统计学意义(P<0.05)。(3)单独局部复发者共18例(17.8%),其中A组7例(15.9%),B组11例(19.3%),平均复发时间14个月;单独远处转移共5例(5.0%),A组1例(2.3%),B组4例(7.0%),平均转移发生时间1年(2~50个月);局部复发伴远处转移者共15例(14.9%)。(4)患者年龄(P=0.03)、肿瘤大小(P=0.01)、骨盆部位(P=0.02),肿瘤是否复发(P=0.004)、组织学分级(P=0.01)、化疗后组织反应(P=0.007)与5年总体生存率相关。多因素分析显示,肿瘤大小(P=0.002)、骨盆部位肿瘤(P=0.01)、肿瘤是否复发(P=0.0004)、组织学分级(P=0.002)、化疗后组织反应(P=0.008)是影响预后的最主要因素。(5)本组病例化疗后一般情况均可,主要并发症为中性粒细胞减少症(79%)。结论采用顺铂、阿霉素及去甲斑蝥素经动脉新辅助化疗能明显增加化疗疗效、提高生存率。该方法是治疗MFH的有效方法。肿瘤部位、大小、组织学分级、是否复发、对化疗反应等因素明显影响预后。
Objective To investigate the effect of neoadjuvant chemotherapy on malignant fibrous histiocytoma (MFH) in soft tissue and to analyze the prognostic factors of MFH in soft tissue. Methods The clinical data of 101 MFH patients with soft tissue admitted to our hospital from September 1999 to December 2011 were retrospectively analyzed. All cases were given chemotherapy cisplatin, doxorubicin, norcantharidin chemotherapy. According to whether the patients treated at the time of treatment, the primary tumor group and the recurrent tumor group were divided into two groups: 44 cases (group A) and 57 cases (group B), and each group was treated with neoadjuvant chemotherapy combined with surgery Neoadjuvant chemotherapy alone or subdivided into two groups. A group of 15 cases of surgical resection, for the A1 group; 29 cases without surgical treatment for the A2 group. In group B, 45 cases of tumor surgery were performed in group B1, while 12 cases were operated in group B2. Tumor necrosis rate was used to evaluate the efficacy of chemotherapy in patients undergoing surgery. The 5-year overall survival rate, 5-year disease-free survival rate, recurrence and metastasis were observed. The age, gender, tumor size, tumor location, depth of tumor infiltration, tumor recurrence, pathological type, histological grade and post- Organizational response and other 9 factors that affect the prognosis of the statistical analysis. Results The group of 101 cases were followed up for 3 to 145 months, an average of 60 months. (1) Tumor necrosis analysis was performed in 23 cases of tumor resection in this study. The tumor necrosis rate was 75.0% in 5 cases of A1 group and 4 cases (80.0%) in group A1. The tumor necrosis rate in group B1 was 73.8 %, And 14 cases (77.8%) had good response to chemotherapy. There was no significant difference in tumor necrosis rate and chemotherapy response rate between the two groups (P> 0.05). (2) The overall survival rate was 65.3% in this group. The 5-year disease-free survival rate and overall survival rate were 70.5% and 75.0% in the primary group, respectively. The 5-year disease-free survival rate and overall survival rate were 56.1% and 57.9% %, The overall survival rate of the two groups compared, the difference was statistically significant (P <0.05). There were 18 cases (17.8%) with local recurrence alone, 7 cases (15.9%) in group A and 11 cases (19.3%) in group B, with an average recurrence time of 14 months. (2.3%) in group A, 4 (7.0%) in group B, and 1 year (2-50 months) in mean group B; 15 cases (14.9%) had local recurrence with distant metastasis. (4) The patient’s age (P = 0.03), tumor size (P = 0.01), pelvic region (P = 0.02), tumor recurrence (P = 0.004), histological grade P = 0.007) was associated with 5-year overall survival. Multivariate analysis showed that tumor size (P = 0.002), pelvic tumor (P = 0.01), tumor recurrence (P = 0.0004), histological grade (P = 0.002) The most important factor affecting the prognosis. (5) The general condition after chemotherapy in this group may be, the main complication is neutropenia (79%). Conclusion The use of cisplatin, doxorubicin and norcantharidin via arterial neoadjuvant chemotherapy can significantly increase the curative effect and improve the survival rate. This method is an effective method of treating MFH. Tumor location, size, histological grade, whether recurrence, the response to chemotherapy and other factors significantly affect the prognosis.