[Treatment and analysis of prognostic factors of stage Ⅱ and Ⅲ undifferentiated high-grade pleomorphic sarcoma in extremities and trunk].

Objective: To evaluate the efficacy and prognostic factors of comprehensive treatment of undifferentiated high grade pleomorphic sarcoma (UHGPS) in extremities and trunk, including surgery, radiotherapy and chemotherapy. Methods: A retrospective analysis and follow-up of 131 UHGPS cases with clinical stage Ⅱ or Ⅲ in extremities and trunk soft tissue was performed to analyze the prognostic factors. Survival data were collected through follow-up. The survival rate was calculated with life table method and Kaplan-Meier survival curves were drawn. Survival rate between the two groups was compared using Log rank test. The multivariate analysis was performed using Cox regression model. Results: The median survival time of 131 patients was 41.6 months. The 1-year, 3-year and 5-year survival rates were 95.0%, 82.0%, and 77.0%, respectively. The 5-year recurrence-free survival rate was 81.0%, and the 5-year metastasis-free survival rate was 72.0%. Univariate analysis showed that the tumor size, initial or recurrence, surgical margin, AJCC stage, and with/without standard treatment were associated with overall survival (all P<0.05). Stratification analysis according to the American Joint Committee of Cancer (AJCC) stage showed that 5-year survival rate of stage Ⅱ patients with radiotherapy was 100.0%, which was higher than that of patients without radiotherapy (79.6%) and the difference was statistically significant (P=0.010); but no statistical significance of radiotherapy for stage Ⅲ and chemotherapy for stage Ⅱ or Ⅲ patients (all P>0.05). The multivariate analysis showed surgical margin (HR=4.220, P=0.002), with/without standard treatment (HR=4.040, P=0.030) were independent risk factors associated with prognosis of UHGPS patients. Conclusions: For UHGPS with stage Ⅱ or stage Ⅲ in extremities and trunk soft tissue, patients with complete resection and standard treatment have improved prognosis. Therefore, standard treatment, including extensive resection for the first surgery, should be performed according to expert consensus in order to increase the long-term survival rate. Adjuvant radiotherapy should be performed for stage Ⅱ patients.目的： 评价四肢和躯干Ⅱ～Ⅲ期未分化高级别多形性肉瘤(UHGPS)手术、放疗、化疗等综合治疗的疗效及预后影响因素。 方法： 对131例发生于四肢和躯干软组织的Ⅱ～Ⅲ期UHGPS患者的临床资料进行回顾性分析。通过随访收集生存数据，生存率以寿命表法计算，绘制Kaplan－Meier生存曲线。两组间生存率的比较采用Log rank检验，多因素分析采用Cox回归模型。 结果： 131例患者的中位生存时间为41.6个月。1、3、5年生存率分别为95.0%、82.0%、77.0%，5年无复发生存率为81.0%，5年无转移生存率为72.0%。单因素分析显示，肿瘤大小、初发或复发、手术切缘、美国癌症联合委员会(AJCC)分期、是否规范化治疗与UHGPS患者的预后有关(均P<0.05)。按照AJCC分期分层分析显示，Ⅱ期患者中，接受放疗者的5年生存率为100.0%，高于未接受放疗者(79.6%)，差异有统计学意义(P＝0.010)；但放疗对Ⅲ期、化疗对Ⅱ期或Ⅲ期患者的5年生存率均无影响(均P>0.05)。多因素分析显示，手术切缘(HR＝4.220，P＝0.002)、是否规范化治疗(HR＝4.040，P＝0.030)为UHGPS患者的独立预后影响因素。 结论： 对于发生于四肢和躯干软组织的Ⅱ～Ⅲ期UHGPS，切除完全、治疗规范是影响患者预后的重要因素。为提高患者的远期生存率，需按照专业共识进行规范化治疗，初治应尽可能达到广泛切除。对于临床分期为Ⅱ期的患者，应行辅助放疗。.