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首页> 美国卫生研究院文献>Annals of Surgery >Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons.
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Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons.

机译：成人软组织肉瘤。美国外科医生学院的护理调查模式。

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A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 patients) and 645 institutions in 1983-1984 (3457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.
机译：在美国外科医生学院癌症委员会的主持下，对成人软组织肉瘤的临床表现，病理学和处理进行了全国性调查。使用两个单独的两年期来评估护理方式的变化。数据来自1977-1978年的504家医院（2355名患者）和1983-1984年的645家机构（3457名患者）。感兴趣的预处理结果包括一些证据，这些证据表明医师延迟诊断，过度使用切除活检（与通常首选的切开活检方法相反），美国癌症分期联合委员会（AJCSS）系统的使用率较低以及对癌症的主要依赖CT用于治疗前患者评估。在大约四分之三的患者中，手术是有或没有辅助治疗的主要治疗方法。另外四分之一主要是在诊断时有远处转移的患者。在第二阶段中确实发生了多式联运疗法的一些增加，但是在所研究的两个时期中，截肢率均较低（约10％）。生存曲线支持AJCCS系统的预后有效性以及软组织肉瘤完全切除的价值。不良预后因素包括手术切缘阳性，大肿瘤，腹膜后或纵隔原发部位，某些组织学类型以及认为需要辅助治疗。由于用于选择这些疗法的患者的标准，接受辅助放疗或化学疗法的患者比单独接受手术的患者具有较差的生存数据。 1977-1978年治疗系列中约有一半的治疗失败是局部性的，而18％的治疗仅限于肺转移。这两种形式的治疗失败的挽救疗法的5年生存率分别为61％和21％。

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