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目的 探讨隆突型皮肤纤维肉瘤 (DFSP)的治疗及其影响预后的因素。方法 对 74例经病理证实的隆突型皮肤纤维肉瘤 (DFSP)患者进行回顾性分析。其中 ,72例行广泛切除术 ,2例行局部切除。 5 2例行单纯手术治疗 ,2 2例加术后放疗。放射治疗采用 6Mev电子线 +60 Coγ线 ,或 6Mev电子线 +后装 ,或单纯电子线照射。 17例采用连续照射 ,5例采用分段治疗 ,照射剂量 5 0～ 70Gy。全部患者均未行化疗和其他治疗。以Cox比例风险模型进行多因素分析 ,以Kaplan Meier法计算无复发生存时间 ,以Logrank检验进行结果之间的比较。结果 剔除 2例失访病例 ,全组复发率为 2 8.4 % ,5年无复发生存率为 6 6 .6 % ,10年无复发生存率为 5 2 .5 %。多因素分析结果显示 ,放疗与否和术后病理切缘为独立预后因素。术后放疗组与单纯手术组的 5年无复发生存率分别为 90 .0 %和 5 8.4 % ,10年无复发生存率分别为 83.3%和 4 1.2 % (P <0 .0 5 ) ;病理切缘阴性和阳性的 5年无复发生存率分别为75 .0 %和 5 7.5 % ,10年无复发生存率分别为 5 6 .6 %和 4 1.4 % (P <0 .0 5 )。结论 术后放疗与否和术后病理切缘为DFSP的独立预后因素。
Objective To investigate the treatment of protuberant type dermatofibrosarcoma (DFSP) and its prognostic factors. Methods A retrospective analysis was performed on 74 pathologically confirmed patients with dural fibrosarcoma (DFSP). Among them, 72 cases underwent extensive resection and 2 cases underwent partial resection. 52 cases were treated with simple surgery, 22 cases with postoperative radiotherapy. Radiation therapy using 6Mev electronic line +60 Coγ line, or 6Mev electronic line + after the installation, or simply electron beam irradiation. Seventeen patients received continuous irradiation and five patients received sub-treatment. The irradiation dose was 50-70 Gy. All patients did not receive chemotherapy and other treatment. Multivariate analysis was performed using the Cox proportional hazards model, and the recurrence-free survival time was calculated using the Kaplan-Meier method. Logrank test was used to compare the results. Results No cases were found in 2 cases. The recurrence rate of the whole group was 2 8.4%. The 5-year recurrence-free survival rate was 66.6%. The 10-year recurrence-free survival rate was 52.5%. Multivariate analysis showed that radiotherapy or not and postoperative pathological margins as independent prognostic factors. The 5-year recurrence-free survival rates of the postoperative radiotherapy group and the surgery alone group were 90.0% and 5 8.4%, respectively, and the 10-year recurrence-free survival rates were 83.3% and 42.2% (P <0.05) respectively. The 5-year recurrence-free survival rates of negative and positive margins were 75.0% and 7.57%, respectively. The 10-year recurrence-free survival rates were 56.6% and 41.4%, respectively (P <0.05). Conclusions Postoperative radiotherapy or postoperative pathologic margin is an independent predictor of DFSP.