Background: Soft tissue sarcomas are a group of rare neoplasms which can be mistaken for benign masses and be excised in a non-oncologic fashion (unplanned excision). Whether unplanned excision (UE) is associated with worse outcomes is highly debated due to conflicting evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines. Main outcomes analyzed were five-year overall survival (OS), five-year local recurrence-free survival (LRFS), amputation rate and plastic reconstruction surgery rate. Risk ratios were used to compare outcomes between patients treated with planned and unplanned excision. Results: We included 16,946 patients with STS, 6017 (35.5%) with UE. UE was associated with worse five-year LRFS (RR 1.35,p= 0.019). Residual tumor on the tumor bed was associated with lower five-year LRFS (RR = 2.59,p< 0.001). Local recurrence was associated with worse five-year OS (RR = 1.82,p< 0.001). UE was not associated with a worse five-year OS (RR = 0.90,p= 0.16), higher amputation rate (RR = 0.77,p= 0.134), or a worse plastic reconstruction surgery rate (RR = 1.25,p= 0.244). Conclusions: Unplanned excision of Soft Tissue Sarcomas and the presence of disease in tumor bed after one were associated with worse five-year LRFS. Tumor bed excision should remain the standard approach, with special consideration to the presence of residual disease.
背景：软组织肉瘤是一组罕见的肿瘤，可能被误诊为良性肿块并以非肿瘤学方式（非计划性切除）进行切除。由于证据相互矛盾，非计划性切除是否与更差的预后相关存在高度争议。方法：我们遵循PRISMA指南进行了系统综述和荟萃分析。主要分析结果为五年总生存率、五年局部无复发生存率、截肢率及整形重建手术率。采用风险比比较计划性切除与非计划性切除患者的预后差异。结果：研究共纳入16,946例软组织肉瘤患者，其中6,017例（35.5%）接受非计划性切除。非计划性切除与较差的五年局部无复发生存率相关（风险比1.35，p=0.019）。肿瘤床残留病灶与更低的五年局部无复发生存率相关（风险比2.59，p<0.001）。局部复发与较差的五年总生存率相关（风险比1.82，p<0.001）。非计划性切除与五年总生存率下降（风险比0.90，p=0.16）、截肢率升高（风险比0.77，p=0.134）或整形重建手术率恶化（风险比1.25，p=0.244）无显著关联。结论：软组织肉瘤的非计划性切除及术后肿瘤床存在病灶与较差的五年局部无复发生存率相关。肿瘤床切除仍应作为标准治疗方式，并需特别关注残留病灶的存在。
肿瘤(癌症)患者之家