MacNeill Andrea J, Miceli Rosalba, Strauss Dirk C, Bonvalot Sylvie, Hohenberger Peter, Van Coevorden Frits, Rutkowski Piotr, Callegaro Dario, Hayes Andrew J, Honoré Charles, Fairweather Mark, Cannell Amanda, Jakob Jens, Haas Rick L, Szacht Milena, Fiore Marco, Casali Paolo G, Pollock Raphael E, Raut Chandrajit P, Gronchi Alessandro, Swallow Carol J
Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy.
Cancer. 2017 Jun 1;123(11):1971-1978. doi: 10.1002/cncr.30572. Epub 2017 Feb 2.
Despite a radical surgical approach to primary retroperitoneal sarcoma (RPS), many patients experience locoregional and/or distant recurrence. The objective of this study was to analyze post-relapse outcomes for patients with RPS who had initially undergone surgical resection of their primary tumor at a specialist center.
All consecutive patients who underwent macroscopically complete resection for primary RPS at 8 high volume centers from January 2002 to December 2011 were identified, and those who developed local recurrence (LR) only, distant metastasis (DM) only, or synchronous local recurrence and distant metastasis (LR+DM) during the follow-up period were included. Overall survival (OS) was calculated for all groups, as was the crude cumulative incidence of a second recurrence after the first LR. Multivariate analyses for OS were performed.
In an initial series of 1007 patients with primary RPS, 408 patients developed recurrent disease during the follow-up period. The median follow-up from the time of recurrence was 41 months. The median OS was 33 months after LR (n = 219), 25 months after DM (n = 146), and 12 months after LR+DM (n = 43), and the 5-year OS rates were 29%, 20%, and 14%, respectively. Predictors of OS after LR were the time interval to LR and resection of LR, while histologic grade approached significance. For DM, significant predictors of OS were the time interval to DM and histologic subtype. The subgroup of patients who underwent resection of recurrent disease had a longer median OS than patients who did not undergo resection.
Relapse of RPS portends high disease-specific mortality. Patients with locally recurrent or metastatic disease should be considered for resection. Cancer 2017;123:1971-1978. © 2017 American Cancer Society.
尽管对原发性腹膜后肉瘤（RPS）采取了根治性手术方法，但许多患者仍会出现局部和/或远处复发。本研究的目的是分析最初在专科中心接受原发性肿瘤手术切除的RPS患者复发后的结局。
确定了2002年1月至2011年12月期间在8个高容量中心接受原发性RPS宏观完全切除的所有连续患者，并纳入了在随访期间仅发生局部复发（LR）、仅发生远处转移（DM）或同时发生局部复发和远处转移（LR+DM）的患者。计算了所有组的总生存期（OS）以及首次LR后第二次复发的粗累积发生率。对OS进行了多变量分析。
在最初的1007例原发性RPS患者系列中，408例患者在随访期间出现复发性疾病。复发后的中位随访时间为41个月。LR后（n = 219）的中位OS为33个月，DM后（n = 146）为25个月，LR+DM后（n = 43）为12个月，5年OS率分别为29%、20%和14%。LR后OS的预测因素是至LR的时间间隔和LR的切除，而组织学分级接近显著水平。对于DM，OS的显著预测因素是至DM的时间间隔和组织学亚型。接受复发性疾病切除的患者亚组的中位OS比未接受切除的患者更长。
RPS复发预示着高疾病特异性死亡率。局部复发或转移性疾病的患者应考虑进行切除。《癌症》2017年；123：1971 - 1978。©2017美国癌症协会。
