Background: Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. Methods: This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. Results: Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53–0.93;p= 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. Conclusions: RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.
背景：对于肢体或躯干软组织肉瘤（STS）是否应常规进行再切除（RE）作为辅助治疗，以及其是否能改善无转移生存期（MFS），目前仍存在争议。本研究进一步探讨了在非NETSARC参考中心进行的计划外肉眼完全切除（UE）或二次切除后，手术切缘状态对预后的影响。方法：这项大规模全国性研究使用了2010年至2019年间在法国参考中心外经历UE的患者数据，这些数据来自法国全国性前瞻性队列NETSARC。报告了接受再切除（RE）与未再切除（No-RE）患者的特征及生存分布。采用多变量Cox比例风险模型调整经典预后因素，并进行亚组分析以确定哪些患者可能从RE中获益。结果：在2371例于NETSARC参考中心外接受STS的UE患者中，1692例在治疗决策前未经多学科团队评估且有二次手术记录。其中913例接受了再切除，779例未再切除。RE与No-RE组在患者年龄、肿瘤部位、大小、深度、分级和组织学类型方面存在显著差异。单变量分析显示，最终R0切缘与更好的MFS相关；首次手术记录为R1切缘的患者比首次R0切除的患者MFS更佳。研究确定RE是MFS的独立有利因素（HR 0.7，95% CI 0.53–0.93；p=0.013）。除老年患者（>70岁）和大肿瘤患者（>10 cm）外，所有亚组均通过RE获得更优的MFS。结论：对于在参考中心外接受肉眼完全切除UE的肢体或躯干STS患者，以及初始定义为R0切缘的切除患者，可考虑进行RE以改善局部无复发生存期和MFS。不建议对70岁以上或肿瘤大于10 cm的患者常规进行RE。
肿瘤(癌症)患者之家