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頁籤選單縮合
題名 | Malignant Fibrous Histiocytoma--An Institutional Experience and Literature Review=惡性纖維組織細胞瘤--高雄榮民總醫院的經驗 |
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作者 | 黃士財; 陳理維; 楊國強; 徐圭璋; 林政達; 陳錦時; 劉文忠; Huang, Shih-tsai; Chen, Lee-wei; Yang, Kuo-chung; Hsu, Kuei-chang; Lin, Cheng-ta; Chen, Jin-shyr; Liu, Wen-chung; |
期刊 | 臺灣整形外科醫學會雜誌 |
出版日期 | 20141200 |
卷期 | 23:4 2014.12[民103.12] |
頁次 | 頁312-324 |
分類號 | 415.138 |
語文 | eng |
關鍵詞 | 惡性纖維組織細胞瘤; 肉瘤; 復發; 肺轉移; Malignant fibrous histiocytoma; Sarcoma; Recurrence; Lung metastasis; |
中文摘要 | 背景:惡性纖維組織瘤是具有侵犯性的軟組織肉瘤。儘管在化學及放射線治療上有進展,廣泛性切除仍是最重要的治療方法。然而局部復發率及遠端肺轉移仍然很高。更深入的了解這個腫瘤可增進疾病的控制。目的及目標:本篇文章的目的在於回顧本院關於惡性纖維組織瘤的治療經驗。材料及方法:回溯性收集本院自1982六月至2013十月間診斷為惡性組織纖維瘤的資料。針對其中發生在軀幹及肢體的可切除腫瘤,進一步討論相關的預後情形。結果:在過去本院共有57位病患診斷為惡性組織纖維瘤。其中發生位置為軀體及四肢的病人且可接受廣泛性切除的病人,共有33位。其中15位術後發生局部復發(45%),時間中位數為12個月,其中11位(73%)發生於兩年內。11位發生肺轉移(33%),時間中位數為16個月,10位(91%)發生於38個月內。年紀大於70歲、男性、腫瘤大於5公分、位於近端肢體、及發炎細胞型態的惡性纖維組織瘤傾向有較高的局部復發及肺轉移風險。雖然這些較大、發炎性的、或腫瘤病理上的安全範圍較短的腫瘤有接受術後輔助放射線或化學治療,卻仍有較高的復發及肺轉移機率。局部復發是肺轉移的顯著危險因子。此疾病的三年存活率為85%,五年存活率為72%。肺轉移後存活時間中位數為6個月。結論:針對惡性纖維組織瘤,一開始就要積極的廣泛性切除來降低局部復發。術後至少三年的追蹤是必要的,特別是在病人年紀大於70歲、男性、腫瘤大於5公分、位於近端肢體、發炎細胞型態及安全範圍較短的情況下。一旦發生局部復發,肺轉移可能會隨之而來,儘早發現才可將肺轉移病灶切除而獲得較好的存活。 |
英文摘要 | Background: Malignant fibrous histiocytoma (MFH) is an aggressive clinical biological behavior soft tissue sarcoma. Despite of advance in adjuvant chemotherapy and radiotherapy, wide excision is the paramount treatment. However, the rate of local recurrence and distant metastasis still remained high. Detailed understanding of tumor behavior would improve therapeutic control. Aim and Objectives: The purpose of this study is to provide our experience in treating MFH. Materials and Methods: An institutional review was performed retrospectively on patients diagnosed with MFH between June 1982 and October 2013. A subgroup analysis was carried out on the tumor located in head, neck, trunk and extremities after wide excision. Results: Fifty-seven patients were diagnosed with MFH in our institution. In them, thirty-three patients were enrolled by MFH over head, neck, trunk and extremities and receiving wide excision. Local recurrences occurred in 15 patients (45%), and 11 of 15 patients (73%) occurred within 2 years with median interval of 12 months. Lung metastasis occurred in 11 patients (33%), and 10 of 11 patients (91%) presented within 38 months with median interval of 16 months. Higher local recurrence and lung metastasis was observed in patients of age ≧70 years, male, tumor size ≧ 5 cm, proximal site of extremity, and inflammatory pathologic subtype. Adjuvant radiotherapy or chemotherapy were suggested for tumor with larger size, inflammatory subtype and close tumor-free margin, but higher local recurrence and lung metastasis still occurred. Local recurrence was an independent factor to lung metastasis and influenced prognosis significantly. Overall survival was about 85% at 3 years and 72% at 5 years. The median survival time after pulmonary metastasis was 6 months. Conclusion: Aggressive wide excision should be performed at initial operation to decrease local recurrence of MFH. A strict postoperative follow-up at least 3 years is necessary, especially in patients over 70 years of age, male, tumor size ≧ 5 cm, proximal tumor location, inflammatory subtype, and close tumor-free margin. If local recurrence occurred, lung metastasis would follow and should be detected as early as possible for possible metastasectomy. |
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