Department of Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Department of Pathology, Brigham and Women's Hospital, Boston, MA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA.
J Am Coll Surg. 2014 Feb;218(2):206-17. doi: 10.1016/j.jamcollsurg.2013.10.009. Epub 2013 Oct 25.
Although sarcoma histology is recognized as a prognostic factor, most studies of retroperitoneal sarcomas report results combining multiple histologies and are inadequately powered to identify prognostic factors specific to a particular histology. We reviewed our experience with retroperitoneal dedifferentiated liposarcoma (RP DDLPS) to identify factors predictive of outcomes.
All patients with RP DDLPS treated at our institution between 1998 and 2008 were reviewed. Multivariable Cox regression analyses were performed to identify factors predictive of progression-free survival (PFS), local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and overall survival (OS).
We identified 119 patients with primary DDLPS. Median tumor size was 20.5 cm; 21% were multifocal. French Federation of Cancer Centers Sarcoma Group tumor grades were intermediate in 53% of patients and high in 28% (unknown 19%). Resections were complete (R0/R1) in 80% of patients and incomplete (R2) in 11% (unknown 9%). Tumors were removed intact in 72% of patients and fragmented in 16% (unknown 12%). Median follow-up was 74.1 months. One hundred patients (84%) experienced recurrence or progression, with 92% occurring in the retroperitoneum. Median PFS, LRFS, DRFS, and OS were 21.1, 21.5, 45.8, and 59.0 months, respectively, and were significantly worse with R2 resection. On multivariate analysis, tumor integrity (intact vs fragmented) was predictive of PFS, multifocality predicted LRFS, and extent of resection (R0/R1 vs R2), grade, and tumor integrity predicted OS.
In this cohort of primary RP DDLPS, factors under surgeon control (tumor integrity, extent of resection) and reflective of tumor biology (grade, multifocality) impact patient outcomes.
虽然肉瘤组织学被认为是一个预后因素，但大多数腹膜后肉瘤的研究报告结果结合了多种组织学，并且没有足够的能力来确定特定组织学的预后因素。我们回顾了我们在腹膜后去分化脂肪肉瘤（RP DDLPS）中的经验，以确定预测结果的因素。
回顾了 1998 年至 2008 年在我院治疗的所有原发性 DDLPS 患者。进行多变量 Cox 回归分析，以确定无进展生存（PFS）、局部无复发生存（LRFS）、远处无复发生存（DRFS）和总生存（OS）的预测因素。
我们确定了 119 例原发性 DDLPS 患者。肿瘤大小中位数为 20.5cm；21%为多灶性。法国癌症中心肉瘤组肿瘤分级在 53%的患者中为中级，在 28%的患者中为高级（未知 19%）。80%的患者手术切除完整（R0/R1），11%的患者手术切除不完整（R2）（未知 9%）。72%的患者肿瘤完整切除，16%的患者肿瘤破碎切除（未知 12%）。中位随访时间为 74.1 个月。100 例（84%）患者出现复发或进展，其中 92%发生在腹膜后。PFS、LRFS、DRFS 和 OS 的中位数分别为 21.1、21.5、45.8 和 59.0 个月，R2 切除与预后明显相关。多变量分析显示，肿瘤完整性（完整与破碎）与 PFS 相关，多灶性与 LRFS 相关，手术切除范围（R0/R1 与 R2）、分级和肿瘤完整性与 OS 相关。
在这组原发性 RP DDLPS 中，受外科医生控制的因素（肿瘤完整性、切除范围）和反映肿瘤生物学的因素（分级、多灶性）影响患者的结局。
