FAVOURABLE ONCOLOGIC AND FUNCTIONAL OUTCOMES FOLLOWING TREATMENT FOR SOFT-TISSUE SARCOMAS OF THE HAND
Notice bibliographique
Résumé
The treatment of soft tissue sarcomas (STS) of the hand poses a challenging problem due to the high risk of postoperative functional deficits and complications. Negative-margin resection combined with radiotherapy is the standard of care for these tumors in other anatomic locations. However, the lack of readily expendable tissue, poorly defined tissue planes, and close proximity to key anatomical structures make this strategy problematic in the hand. Additionally, radiotherapy of the hand is thought to be associated with an increased risk of overall complications and poorer functional outcomes compared to other anatomic sites. Therefore, this study aims to assess the oncologic and functional outcomes of patients treated for STS of the hand. We performed a retrospective review of all patients treated at our tertiary referral sarcoma center from 1986–2021. All patients above the age of 18 with a biopsy-proven STS of the hand distal to the radiocarpal joint were identified from a prospectively updated database and included. All patients underwent planned negative margin surgery with or without perioperative radiotherapy. Outcomes of interest include local recurrence-free survival, overall survival, and functional outcomes. Functional scores were evaluated using the Toronto Extremity Salvage Score (TESS), Musculoskeletal Tumor Society Rating Scale (MSTS), and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Seventy-one patients were treated for STS of the hand, with a mean follow-up of 73.4 months. Of those included, 77% presented with primary non-metastatic disease, and 62% had prior surgery outside our institution. 73.2% of patients underwent limb-sparing surgery, whilst 21.1% had a ray resection, and 5.6% underwent a hand amputation. 26 patients (36%) had primary wound closure and 26 (36%) required a separate soft tissue reconstruction procedure. 54 (76.1%) patients underwent perioperative radiotherapy (62% preop), and only 14% received chemotherapy. 58 (81.7%) procedures achieved a negative margin, while the remaining 13 (18.3%) had a microscopic positive margin. Wound complications were observed in 14% of patients. One patient had a vascular-related complication requiring grafting. Local recurrence-free survival at 10 years was 86.9%. Overall survival at 5 and 10 years were 76% and 57%, respectively. At the final follow-up, the mean functional scores were: TESS – 96.8, MSTS – 89, and DASH − 10.4. In contrast to prior studies, these results demonstrate a relatively low complication rate following resection of STS of the hand, even when combined with perioperative radiotherapy. The data also supports that perioperative radiation can be safely administered to patients with STS of the hand to facilitate low rates of local recurrence and excellent functional results.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».