Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Prognostic Indicators of Extremity Liposarcoma

사지에 발생하는 지방육종의 예후 인자에 대한 분석

  • Park, Kee Young (Department of Orthopedic Surgery, Pusan National University School of Medicine) ;
  • Kim, Jeung Il (Department of Orthopedic Surgery, Pusan National University School of Medicine) ;
  • Lee, In Sook (Department of Radiology, Pusan National University School of Medicine) ;
  • Song, You Seon (Department of Radiology, Pusan National University School of Medicine) ;
  • Choi, Kyung Un (Department of Pathology, Pusan National University School of Medicine)
  • 박기영 (부산대학교 의학전문대학원 정형외과학교실) ;
  • 김정일 (부산대학교 의학전문대학원 정형외과학교실) ;
  • 이인숙 (부산대학교 의학전문대학원 영상의학교실) ;
  • 송유선 (부산대학교 의학전문대학원 영상의학교실) ;
  • 최경운 (부산대학교 의학전문대학원 병리학교실)
  • Received : 2019.04.23
  • Accepted : 2019.09.03
  • Published : 2020.08.30
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this retrospective study was to define the prognostic factors for liposarcoma to aid in the selection of effective treatments. Materials and Methods: This study analyzed 41 cases out of 45 cases diagnosed with and treated for liposarcoma 2002 to 2015; 4 cases of well-differentiated liposarcoma were excluded. The effects of sex, age, site, stage, and histological classification on survival were analyzed retrospectively. For 28 cases diagnosed with myxoid liposarcoma, additional analysis was performed after the inclusion of round cell components. Results: The mean age at diagnosis was 52.05 years (range 25-82 years) and the average follow-up period was 63.7 months. The disease-free survival rate was 43.2%. Most factors, including sex and age, were not significantly associated with the survival rate. On the other hand, the stage (Musculoskeletal Tumor Society stage) was significantly associated with the survival rate. The survival rate of patients with myxoid liposarcoma was 69% and the local recurrence and metastasis results varied according to the presence of round cells. Conclusion: The stage of liposarcoma and the sex of the patient were found to be effective factors for prognosis. When planning the treatment for liposarcoma, the treatment outcome for liposarcoma differs according to several prognostic factors.

목적: 지방육종의 치험 예들을 분석하여 생존율에 영향을 미치는 예후 인자를 밝히고, 향후 효과적인 치료의 접근에 도움이 되고자 한다. 대상 및 방법: 2002년부터 2015년까지 지방육종으로 진단, 치료받은 환자 총 45예 중 고분화 지방육종 4예를 제외한 41예를 분석하였다. 성별, 나이, 발생 부위, 병기, 조직학적 분류, 방사선 치료, 항암 화학 치료 등이 무병 생존율에 미치는 영향에 대한 후향적 연구를 시행하였다. 점액성 지방육종으로 진단된 28예에 대해서는 원형세포 성분 포함 여부에 따른 분석을 추가로 진행하였다. 결과: 진단 시 평균 연령은 52.05세(25-82세), 평균 추시 기간은 63.7개월이었으며, 평균적인 무병 생존율은 41.7%였다. 점액성 지방육종의 경우 무병 생존율은 43.2%였다. 분석 결과 나이, 발생 부위 조직학적 분류 등은 무병 생존율에 영향을 미치지 못하였으나 병기(Musculoskeletal Tumor Society stage)와 성별에서 통계적으로 유의한 연관을 나타내었다. 점액성 지방육종에 대해서는 원형세포 성분에 따른 결과의 차이를 보이지 않았다. 결론: 지방육종의 병기와 환자의 성별이 예후에 영향을 미치는 유효한 인자로 나타났다. 지방육종은 여러 예후 인자들에 의해 치료 결과에 차이를 보이므로, 치료에 있어 이러한 점을 고려하여야 한다.

Keywords

Acknowledgement

본 연구는 2018년도 부산대학교병원 임상연구비 지원으로 이루어졌음.

References

  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106-30. https://doi.org/10.3322/canjclin.56.2.106
  2. Fletcher CDM, Unni KK, Mertens F; World Health Organization, International Academy of Pathology. Pathology and genetics of tumours of soft tissue and bone: World Health Organization classification of tumours. Lyon: IARC Press; 2002. 35-46.
  3. Mankin HJ, Hornicek FJ. Diagnosis, classification, and management of soft tissue sarcomas. Cancer Control. 2005;12:5-21. https://doi.org/10.1177/107327480501200102
  4. Weiss SW, Goldblum JR. Enzinger and Weiss's soft tissue tumors. 4th ed. St. Louis: Mosby; 2001. 641-93.
  5. Kilpatrick SE, Doyon J, Choong PF, Sim FH, Nascimento AG. The clinicopathologic spectrum of myxoid and round cell liposarcoma. a study of 95 cases. Cancer. 1996;77:1450-8. https://doi.org/10.1002/(SICI)1097-0142(19960415)77:8<1450::AID-CNCR5>3.0.CO;2-G
  6. Nascimento AG. Dedifferentiated liposarcoma. Semin Diagn Pathol. 2001;18:263-6.
  7. Smith TA, Easley KA, Goldblum JR. Myxoid/round cell liposarcoma of the extremities. a clinicopathologic study of 29 cases with particular attention to extent of round cell liposarcoma. Am J Surg Pathol. 1996;20:171-80. https://doi.org/10.1097/00000478-199602000-00005
  8. Schwab JH, Boland P, Guo T, et al. Skeletal metastases in myxoid liposarcoma: an unusual pattern of distant spread. Ann Surg Oncol. 2007;14:1507-14. https://doi.org/10.1245/s10434-006-9306-3
  9. Gustafson P, Dreinhofer KE, Rydholm A. Soft tissue sarcoma should be treated at a tumor center. a comparison of quality of surgery in 375 patients. Acta Orthop Scand. 1994;65:47-50. https://doi.org/10.3109/17453679408993717
  10. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225-49. https://doi.org/10.3322/caac.20006
  11. Linehan DC, Lewis JJ, Leung D, Brennan MF. Influence of biologic factors and anatomic site in completely resected liposarcoma. J Clin Oncol. 2000;18:1637-43. https://doi.org/10.1200/JCO.2000.18.8.1637
  12. Singer S, Antonescu CR, Riedel E, Brennan MF. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg. 2003;238:358-70. https://doi.org/10.1097/00000658-200309000-00007
  13. Antonescu CR, Tschernyavsky SJ, Decuseara R, et al. Prognostic impact of P53 status, TLS-CHOP fusion transcript structure, and histological grade in myxoid liposarcoma: a molecular and clinicopathologic study of 82 cases. Clin Cancer Res. 2001;7:3977-87.
  14. Willett CG, Schiller AL, Suit HD, Mankin HJ, Rosenberg A. The histologic response of soft tissue sarcoma to radiation therapy. Cancer. 1987;60:1500-4. https://doi.org/10.1002/1097-0142(19871001)60:7<1500::AID-CNCR2820600716>3.0.CO;2-1
  15. Nishida Y, Tsukushi S, Nakashima H, Ishiguro N. Clinicopathologic prognostic factors of pure myxoid liposarcoma of the extremities and trunk wall. Clin Orthop Relat Res. 2010;468:3041-6. https://doi.org/10.1007/s11999-010-1396-3
  16. Wu J, Qian S, Jin L. Prognostic factors of patients with extremity myxoid liposarcomas after surgery. J Orthop Surg Res. 2019;14:90. https://doi.org/10.1186/s13018-019-1120-2
  17. Weiss SW. Lipomatous tumors. Monogr Pathol. 1996;38:207-39.
  18. Ezinger FM, Weiss SW. Soft tissue tumors. 3rd ed. St. Louis (MO): Mosby; 1994.
  19. Toguchida J, Yamaguchi T, Ritchie B, et al. Mutation spectrum of the p53 gene in bone and soft tissue sarcomas. Cancer Res. 1992;52:6194-9.
  20. Leach FS, Tokino T, Meltzer P, et al. p53 Mutation and MDM2 amplification in human soft tissue sarcomas. Cancer Res. 1993;53(10 Suppl):2231-4.
  21. Wong CK, Edwards AT, Rees BI. Liposarcoma: a review of current diagnosis and management. Br J Hosp Med. 1997;58:589-91.
  22. DeLaney TF, Rosenberg AE, Harmon DC, et al. Soft tissue sarcomas. In: Price P, Sikora K, ed. Treatment of cancer. 4th ed. London: Arnold; 2003. 869-907.
  23. Spiro IJ, Gebhardt MC, Jennings LC, Mankin HJ, Harmon DC, Suit HD. Prognostic factors for local control of sarcomas of the soft tissues managed by radiation and surgery. Semin Oncol. 1997;24:540-6.