中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (08): 916-921.DOI: 10.19538/j.cjps.issn1005-2208.2024.08.16

• 论著 • 上一篇    下一篇

多学科综合治疗协作组模式对行手术治疗腹膜后脂肪肉瘤病人预后的影响：一项倾向性评分匹配的回顾性队列研究

朱    涛1a，姜    铨1a，王炯元1a，丁玉芹1b，王斌梁1c，杨    珏1d，王毅超1e，张    立1f，侯英勇1g，童汉兴1a，张    勇1a,2，周宇红1h，陆维祺1a   

  1. 1复旦大学附属中山医院 a.腹膜后及软组织肿瘤外科  b.放射科  c.放疗科  d.血管外科  e.骨科  f.泌尿外科  g.病理科  h.肿瘤内科，上海 200030；2复旦大学附属中山医院厦门医院普外科，福建厦门 361015
  • 出版日期:2024-08-01 发布日期:2024-08-23

  • Online:2024-08-01 Published:2024-08-23

摘要： 目的    探讨多学科综合治疗协作组（MDT）诊疗模式对行手术治疗的腹膜后脂肪肉瘤（RLPS）病人生存预后的影响。方法    回顾性分析自2009年1月至2022年12月于复旦大学附属中山医院腹膜后及软组织肿瘤外科就诊的703例RLPS病人的临床病理资料。585例纳入研究，其中210例病人参与MDT（MDT组），375例病人未参与MDT（non-MDT组）。采用倾向性评分匹配法（PSM）对两组病人进行1∶1匹配，最终MDT组和non-MDT组分别纳入208例，对两组病人的相关临床数据进行对比分析。结果    PSM匹配后两组病人的性别、年龄、肿瘤长径、肿瘤数目、肿瘤原发或复发差异无统计学意义（P>0.05）。PSM后多因素Cox分析结果显示，复发肿瘤、法国癌症中心联盟肉瘤学组（FNCLCC）分级Ⅲ级、手术R2切缘是病人总生存期（OS）的独立危险因素；复发肿瘤、多发病灶、FNCLCC分级Ⅲ级、手术R2切缘是无进展生存期（PFS）的独立危险因素。参与MDT是PFS（HR=0.663，95%CI 0.515~0.855，P=0.002）和OS（HR=0.614，95%CI 0.414~0.911，P=0.015）的独立保护因素。MDT组1、3、5年总生存率分别为93.6%、78.9%和71.6%，non-MDT组分别为91.7%、67.2%和60.7%；MDT组1、3、5年无进展生存率分别为78.2%、49.8%和35.5%，non-MDT组分别为68.4%、38.9%和29.8%；MDT组病人总生存率（P=0.017）及无进展生存率（P=0.003）均高于non-MDT组，差异有统计学意义。结论  MDT模式可能有助于改善接受手术治疗的RLPS病人的预后，但具体获益情况需进行个体化评估。

关键词: 腹膜后脂肪肉瘤, 多学科综合治疗协作组, 总生存期, 无进展生存期

Abstract: To investigate the effect of a multidisciplinary team (MDT) model on the prognosis of patients with retroperitoneal liposarcoma (RLPS). Methods    The clinical and pathological data of patients with RLPS treated at the Department of Retroperitoneal Tumor and Soft Tissue Sarcoma Surgery of Zhongshan Hospital, Fudan University from January 2009 to December 2022 were retrospectively analyzed. 210 patients participated in MDT discussions, and 375 patients did not. The two groups of patients were matched 1∶1 by propensity score matching (PSM), and 208 cases were selected in the MDT group and the non-MDT group, respectively. The clinical data of the two groups were analyzed and compared. Results    After PSM matching, there were no statistically significant differences in gender, age, tumor length, tumor number, tumor origin, or recurrence between the two groups (P>0.05). The results of the multivariate Cox analysis after PSM showed that recurrent tumor, FNCLCC grade Ⅲ, and surgical R2 margin status were independent risk factors for overall survival (OS). Recurrent tumor, multiple lesions, FNCLCC grade Ⅲ, and surgical R2 margin status were independent risk factors for progression-free survival (PFS). Whether to participate in MDT was the independent protective factor for  PFS(HR=0.663, 95%CI 0.515-0.855, P=0.002) and OS(HR=0.614, 95%CI 0.414-0.911, P=0.015). The OS  rates at 1, 3, and 5 years were 93.6%, 78.9%, and 71.6% in the MDT group, and 91.7%, 67.2%, and 60.7% in the non-MDT group, respectively. The PFS rates at 1, 3, and 5 years were 78.2%, 49.8%, and 35.5% in the MDT group, and 68.4%, 38.9%, and 29.8% in the non-MDT group, respectively. The OS rate (P=0.017) and PFS rate (P=0.003) in the MDT group were higher than those in the non-MDT group. Conclusion  MDT model may improve the outcomes of patients undergoing surgical treatment for RLPS, but the specific benefits may require individualized assessments.

Key words: retroperitoneal liposarcoma, multidisciplinary team, overall survival, progression-free survival