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背景与目的:成人软组织肉瘤(soft tissue sarcoma,STS)发病率低,化疗效果不肯定。本研究通过分析成人软组织肉瘤病例的临床特征,探讨化疗在成人软组织肉瘤综合治疗中的意义。方法:回顾性分析2000年1月至2005年12月在中山大学肿瘤防治中心诊断为软组织肉瘤,并接受化疗的109例患者的临床资料和化疗情况,统计各一线化疗方案的有效率及患者的生存资料。结果:109例患者中有66例行姑息化疗,40例行辅助化疗,3例行新辅助化疗。姑息化疗患者一线化疗方案的总有效率为22.7%,中位生存期16.9个月,1年和2年生存率分别为63.6%和33.3%,中位无进展生存期为3.4个月。仅发生肺转移的患者中位生存期为25.1个月,仅发生肝转移的患者中位生存期为11.8个月,两者比较差异有统计学意义(P<0.05)。MAID方案是最常用的一线化疗方案,其次是CYVADIC方案,有效率(完全缓解+部分缓解)分别为28.0%和22.2%。确诊后半年内发生转移的患者比半年后转移的患者中位生存期短(11.8个月vs.42.9个月),两者之间差异有统计学意义(P=0.04)。结论:MAID和CYVADIC均为有效的化疗方案,既往使用过常规剂量的阿霉素±异环磷酰胺后进展的患者仍可能从大剂量异环磷酰胺化疗中获益。肝转移患者比肺转移患者对化疗更不敏感,确诊后半年内出现转移的患者预后较确诊半年后转移者差。
BACKGROUND & OBJECTIVE: The incidence of adult soft tissue sarcoma (STS) is low and the effect of chemotherapy is uncertain. This study analyzed the clinical features of adult soft tissue sarcoma cases to explore the significance of chemotherapy in the comprehensive treatment of adult soft tissue sarcoma. Methods: The clinical data and chemotherapy of 109 patients diagnosed as soft tissue sarcoma at Sun Yat-sen University Cancer Center from January 2000 to December 2005 were retrospectively analyzed. The efficacy of each first-line chemotherapy regimen and the rate of patients Survival information. Results: Of the 109 patients, 66 patients underwent palliative chemotherapy, 40 received adjuvant chemotherapy and 3 received neoadjuvant chemotherapy. The first-line chemotherapy regimen for palliative chemotherapy had a total effective rate of 22.7%, a median survival of 16.9 months, a 1-year and 2-year survival rates of 63.6% and 33.3%, respectively, and a median progression-free survival of 3.4 months. The median survival time was 25.1 months in patients with lung metastases only, and 11.8 months in patients with only liver metastases. The difference was statistically significant (P <0.05). The MAID regimen was the most commonly used first-line regimen, followed by the CYVADIC regimen, with efficiencies (complete remission + partial remission) of 28.0% and 22.2%, respectively. Patients who had metastases within six months after diagnosis had a shorter median survival time (11.8 months vs. 42.9 months) than those who had metastases after six months (P = 0.04). Conclusions: Both MAID and CYVADIC are effective chemotherapy regimens, and patients who have previously progressed with a conventional dose of doxorubicin plus ifosfamide may still benefit from high-dose ifosfamide chemotherapy. Patients with liver metastases were less sensitive to chemotherapy than patients with lung metastases, and those with metastases within six months after diagnosis were worse than those who were diagnosed six months after diagnosis.