Читать книгу Veterinary Surgical Oncology - Группа авторов - Страница 150

The prognosis of STS depends on tumor size vs. site, histologic grade, mitotic index, infiltrative growth in surrounding structures, potentially presence of metastasis, and completeness of removal (i.e. the surgical margins) (Ettinger 2003; Kuntz et al. 1997; Dennis et al. 2011). Size is reported to be a prognostic factor for STS (Kuntz et al. 1997), because of the increased difficulty of achieving wide surgical margins for larger tumors in respect of patient morbidity (Liptak and Forrest 2013). Tumor size was also significantly related to survival in feline patients (Dillon et al. 2005).

Mitotic index is an important feature determining histological tumor grade and provides information on the proliferative activity of the tumor. Mitotic index is also independently associated with increased and earlier rates of tumor recurrence, higher rates of metastasis, and reduced overall survival (Bray et al. 2014; Dennis et al. 2011; Ettinger et al. 2006; Kuntz et al. 1997; McSporran 2009).

The most important prognostic factor for local recurrence is complete surgical margins (Baker‐Gabb et al. 2003; Dernell et al. 1998; Kuntz et al. 1997; McSporran 2009; Simon et al. 2007). If complete resection can be achieved most dogs with STS have in general a good prognosis (Bray et al. 2014; Dennis et al. 2011; McSporran 2009; Kuntz et al. 1997).

Following resection, the chance of local tumor recurrence depends on histologic grade and completeness of surgical margins. Most grade I STSs with “close” margins will not recur, but propensity for recurrence increases with grade. Marginal resections lead to recurrence in up to 75% of tumors (in grade III STSs) (McSporran 2009).

Further research is needed to determine more precise estimates for recurrence rates and survival as related to completeness of surgical margins and to delineate potential differences in metastatic rate and median survival time between grades. Other potential indicators of prognosis that presently require further investigation include histologic type, tumor dimension, location, invasiveness, stage, markers of cellular proliferation, and cytogenetic profiles (Bostock and Dye 1980; Bray et al. 2014; Chase et al. 2009; Stefanello et al. 2008).