Background: Sarcomas, a diverse group of malignant tumors arising from mesenchymal tissues, pose significant diagnostic and therapeutic challenges. This study compares the outcomes of planned resections (PEs) and unplanned resections (UEs) to inform better clinical practices. Methods: Data were analyzed from the Swiss Sarcoma Network (SSN), including patients with soft tissue and bone sarcomas treated at two major hospitals. This study utilized logistic regression and Cox regression models to examine the odds of UEs and their impact on local recurrence-free survival. Results: Among 429 patients registered by SSN members, 323 (75%) underwent PEs and 106 (25%) experienced UEs. PEs were associated with significantly larger tumors (94 mm vs. 47 mm,p< 0.001) and higher-grade tumors (Grade 3: 50.5% vs. 37.4%,p= 0.03). Despite achieving superior resection margins (R0: 78.8% vs. 12.6%,p< 0.001), PEs showed higher metastasis rates at follow-up (31.0% vs. 10.4%,p< 0.001) and greater cancer-specific mortality (16.7% vs. 6.6%,p= 0.01). UEs, while linked to higher local recurrence, did not significantly affect metastasis-free survival (MFS) or overall survival (OS). Conclusions: PEs achieve superior immediate surgical outcomes but are linked to higher metastasis and cancer-specific mortality due to the advanced stage of tumors. UEs, while associated with higher local recurrence rates, do not significantly impact MFS or OS. Early detection, comprehensive diagnostics, and timely referrals to specialized sarcoma hubs are essential to avoid UEs and reduce metastatic risk. Future research should focus on developing diagnostic tools using individual tumor and patient characteristics to improve sarcoma management.
背景：肉瘤是一组起源于间叶组织的异质性恶性肿瘤，其诊断与治疗面临重大挑战。本研究通过比较计划性切除术（PEs）与非计划性切除术（UEs）的临床结局，旨在为优化临床实践提供依据。方法：研究数据来源于瑞士肉瘤网络（SSN），纳入两家大型医院收治的软组织与骨肉瘤患者。采用逻辑回归与Cox回归模型分析非计划性切除术的发生概率及其对局部无复发生存期的影响。结果：在SSN成员登记的429例患者中，323例（75%）接受计划性切除术，106例（25%）经历非计划性切除术。计划性切除术组肿瘤体积显著更大（94毫米 vs 47毫米，p<0.001），肿瘤分级更高（3级：50.5% vs 37.4%，p=0.03）。尽管计划性切除术组获得更优的切缘状态（R0切除率：78.8% vs 12.6%，p<0.001），但其随访期间转移率更高（31.0% vs 10.4%，p<0.001），癌症特异性死亡率也更高（16.7% vs 6.6%，p=0.01）。非计划性切除术虽与较高的局部复发率相关，但对无转移生存期（MFS）和总生存期（OS）无显著影响。结论：计划性切除术虽能获得更优的即刻手术效果，但因肿瘤分期较晚，其转移率与癌症特异性死亡率更高。非计划性切除术虽伴随较高局部复发风险，但对无转移生存期和总生存期无显著影响。早期发现、全面诊断并及时转诊至专业肉瘤诊疗中心对避免非计划性切除术、降低转移风险至关重要。未来研究应聚焦于开发基于个体肿瘤特征与患者特质的诊断工具，以提升肉瘤诊疗水平。
肿瘤(癌症)患者之家