Objectives:To evaluate the clinical heterogeneity of sarcomas by examining associations between histological subtypes, metastatic patterns, treatment modalities, and survival outcomes.Methods:We analyzed data from 97,062 adult patients diagnosed with sarcoma between 2000 and 2020, using the Surveillance, Epidemiology, and End Results (SEER) database. Fourteen histological subtypes were included. Propensity score matching (PSM) was employed to adjust for baseline differences, and Cox proportional hazards models were used to identify prognostic variables.Results:The most prevalent subtypes were sarcoma not otherwise specified (31.9%), leiomyosarcoma (17.1%), and liposarcoma (13.9%). Metastatic patterns differed significantly by subtype; liver metastases were most common in sarcomas with small blue round cell (SBRC) features (8.9%) and stromal sarcoma (6.1%), while lung metastases were frequently observed in Ewing sarcoma (10.0%) and rhabdomyosarcoma (9.7%). Median overall survival (mOS) varied widely, ranging from 234 months in chondrosarcoma to 16–20 months in rhabdomyosarcoma and SBRC sarcoma. Overall, patients with primary sarcoma had significantly better survival than those with treatment-related disease (119.0 vs. 45.0 months,p< 0.0001), with this trend consistent across most subtypes. Treatment responses were subtype- and size-dependent. For instance, surgery plus radiotherapy improved outcomes in giant cell sarcoma regardless of tumor size, whereas chemotherapy provided benefit only in tumors larger than 5 cm. Combined surgery and radiotherapy offered additional survival benefit in select subtypes, including chordoma, leiomyosarcoma (>5 cm), and synovial sarcoma (<5 cm).Conclusions:Sarcomas exhibit substantial clinical and prognostic heterogeneity across histological subtypes. These findings underscore the importance of subtype-specific, individualized treatment strategies in optimizing patient outcomes.
目的：通过分析组织学亚型、转移模式、治疗方式与生存结局之间的关联，评估肉瘤的临床异质性。 方法：利用美国监测、流行病学和最终结果（SEER）数据库，对2000年至2020年间诊断为肉瘤的97,062例成年患者数据进行分析。研究涵盖14种组织学亚型。采用倾向性评分匹配（PSM）校正基线差异，并应用Cox比例风险模型识别预后相关变量。 结果：最常见的亚型为未特指型肉瘤（31.9%）、平滑肌肉瘤（17.1%）和脂肪肉瘤（13.9%）。不同亚型的转移模式差异显著：具有小蓝圆细胞（SBRC）特征的肉瘤（8.9%）和间质肉瘤（6.1%）最常见肝转移，而肺转移多见于尤文肉瘤（10.0%）和横纹肌肉瘤（9.7%）。中位总生存期（mOS）差异显著，软骨肉瘤最长（234个月），横纹肌肉瘤和SBRC肉瘤最短（16–20个月）。总体而言，原发性肉瘤患者的生存期显著优于治疗相关肉瘤患者（119.0个月 vs. 45.0个月，p < 0.0001），这一趋势在多数亚型中保持一致。治疗反应具有亚型及肿瘤大小依赖性。例如，无论肿瘤大小，手术联合放疗均能改善巨细胞肉瘤的预后，而化疗仅对直径大于5厘米的肿瘤有益。手术联合放疗在特定亚型（包括脊索瘤、平滑肌肉瘤（>5厘米）和滑膜肉瘤（<5厘米））中可提供额外的生存获益。 结论：肉瘤在不同组织学亚型间表现出显著的临床及预后异质性。这些发现强调了制定亚型特异性个体化治疗策略对优化患者结局的重要性。
Clinical Differences Among Histological Categories of Sarcoma: Insights from 97,062 Patients
肿瘤(癌症)患者之家