Dalal Kimberly Moore, Kattan Michael W, Antonescu Cristina R, Brennan Murray F, Singer Samuel
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Ann Surg. 2006 Sep;244(3):381-91. doi: 10.1097/01.sla.0000234795.98607.00.
To determine the prognostic significance of histologic subtype in a large series of patients with primary liposarcoma (LS) and to construct a LS-specific postoperative nomogram for disease-specific survival (DSS).
Nomograms, used to define and predict outcome following operative intervention, may contain variables not conventionally used in standard staging systems. A 12-year DSS postoperative nomogram for all sarcomas has already been established.
From a single-institution prospective sarcoma database, patients with primary extremity, truncal, or retroperitoneal LS treated between 1982 and 2005 were identified. Histology was reviewed by a sarcoma pathologist and divided into 5 subtypes. A nomogram predictive of 5- and 12-year DSS was developed.
Of 801 patients with primary LS resected with curative intent, 369 (46%) presented with well-differentiated, 143 (18%) dedifferentiated, 144 (18%) myxoid, 81 (10%) round cell, and 64 (8%) pleomorphic histology. The median tumor burden was 15 cm (range, 1-139 cm). At last follow-up, 560 patients were alive with a median follow-up time of 45 months (range, 1-264 months) and 51 months for surviving patients. The 5- and 12-year DSS rates were 83% (95% confidence interval [CI], 80%-86%) and 72% (95% CI, 67%-77%), respectively. The nomogram was drawn on the basis of a Cox regression model. The independent predictors of DSS were age, presentation status, histologic variant, primary site, tumor burden, and gross margin status. The nomogram was internally validated using bootstrapping and shown to have excellent calibration. The concordance index was 0.827 compared with 0.776 for the general sarcoma postoperative nomogram for 12-year DSS.
The LS-specific nomogram based on histologic subtype provides more accurate survival predictions for patients with primary LS than the previously established generic sarcoma nomogram. DSS nomograms aid in more accurate counseling of patients, identification of patients appropriate for adjuvant therapy, and stratification of patients for clinical trials and molecular analysis.
确定组织学亚型在大量原发性脂肪肉瘤（LS）患者中的预后意义，并构建一个用于疾病特异性生存（DSS）的LS特异性术后列线图。
用于定义和预测手术干预后结果的列线图可能包含标准分期系统中未常规使用的变量。已经建立了一个针对所有肉瘤的12年DSS术后列线图。
从一个单机构前瞻性肉瘤数据库中，识别出1982年至2005年间接受治疗的原发性肢体、躯干或腹膜后LS患者。肉瘤病理学家对组织学进行了复查，并将其分为5种亚型。开发了一个预测5年和12年DSS的列线图。
801例接受根治性切除的原发性LS患者中，369例（46%）为高分化，143例（18%）为去分化，144例（18%）为黏液样，81例（10%）为圆形细胞，64例（8%）为多形性组织学。肿瘤负担中位数为15 cm（范围1 - 139 cm）。在最后一次随访时，560例患者存活，中位随访时间为45个月（范围1 - 264个月），存活患者的随访时间为51个月。5年和12年DSS率分别为83%（95%置信区间[CI]，80% - 86%）和72%（95% CI，67% - 77%）。列线图基于Cox回归模型绘制。DSS的独立预测因素为年龄、表现状态、组织学变异、原发部位、肿瘤负担和切缘状态。列线图通过自举法进行内部验证，显示具有良好的校准。一致性指数为0.827，而针对12年DSS的一般肉瘤术后列线图的一致性指数为0.776。
基于组织学亚型的LS特异性列线图比先前建立的通用肉瘤列线图能为原发性LS患者提供更准确的生存预测。DSS列线图有助于更准确地为患者提供咨询服务、识别适合辅助治疗的患者，以及对患者进行分层以开展临床试验和分子分析。
