Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
J Urol. 2011 Jul;186(1):59-65. doi: 10.1016/j.juro.2011.03.030. Epub 2011 May 14.
We determined whether microscopic margin status is an independent prognosticator in patients who underwent complete resection of retroperitoneal sarcoma.
A total of 99 patients with a median age of 55.4 years (range 26.0 to 81.9) underwent complete surgical resection for primary (79) or recurrent (20) retroperitoneal sarcoma between September 1990 and January 2010. Median followup was 36.0 months (range 1.0 to 221.1).
Microscopic involvement of the margins was detected in 24 patients and local recurrence developed in 69 (69.7%). Univariate analysis showed that pain, recurrent disease and higher Fédération Nationale des Centres de Lutte Contre le Cancer grade were associated with an increased risk of local recurrence. On multivariate Cox analysis presenting symptoms and grade were significantly associated with local recurrence-free survival, including pain vs other symptoms (HR 1.7, p = 0.035) and grade 3 vs 1 (HR 2.4, p = 0.028). A total of 25 patients (25.3%) died of retroperitoneal sarcoma. Histological subtype, grade and tumor margin status were prognostic for disease specific survival. Cox regression analysis revealed that certain factors were significantly associated with disease specific survival, including other sarcomas vs liposarcoma (HR 2.8, p = 0.030) and positive vs negative margins (HR 3.4, p = 0.005).
Although complete surgical resection is possible in patients with retroperitoneal sarcoma, the procedure is associated with a high recurrence rate even in patients with negative margins. Microscopically clear margins reliably predict disease specific survival but not local control.
我们确定了在接受腹膜后肉瘤完全切除术的患者中，显微镜下切缘状态是否是一个独立的预后因素。
1990 年 9 月至 2010 年 1 月期间，共有 99 名中位年龄为 55.4 岁（范围 26.0 至 81.9）的患者因原发性（79 例）或复发性（20 例）腹膜后肉瘤接受了完全手术切除。中位随访时间为 36.0 个月（范围 1.0 至 221.1）。
24 例患者显微镜下切缘受累，69 例（69.7%）局部复发。单因素分析显示，疼痛、复发性疾病和更高的法国国家癌症中心分级与局部复发风险增加相关。在多变量 Cox 分析中，表现症状和分级与局部无复发生存显著相关，包括疼痛与其他症状（HR 1.7，p = 0.035）和 3 级与 1 级（HR 2.4，p = 0.028）。共有 25 名患者（25.3%）死于腹膜后肉瘤。组织学亚型、分级和肿瘤切缘状态是疾病特异性生存的预后因素。Cox 回归分析显示，某些因素与疾病特异性生存显著相关，包括其他肉瘤与脂肪肉瘤（HR 2.8，p = 0.030）和阳性与阴性切缘（HR 3.4，p = 0.005）。
尽管腹膜后肉瘤患者可以进行完全手术切除，但即使在切缘阴性的患者中，该手术也与高复发率相关。显微镜下无肿瘤切缘可靠地预测疾病特异性生存，但不能预测局部控制。
