Leiting Jennifer L, Bergquist John R, Hernandez Matthew C, Merrell Kenneth W, Folpe Andrew L, Robinson Steven I, Nagorney David M, Truty Mark J, Grotz Travis E
Department of Surgery, Mayo Clinic, Rochester, MN 55901, USA.
Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55901, USA.
Sarcoma. 2018 Dec 5;2018:7972389. doi: 10.1155/2018/7972389. eCollection 2018.
Perioperative radiation therapy (RT) has been associated with reduced local recurrence in patients with retroperitoneal sarcomas (RPS); however, selection criteria remain unclear. We hypothesized that perioperative RT would improve survival in patients with RPS and would be associated with pathological factors. The National Cancer Database (NCDB) from 2004 to 2012 was reviewed for patients with nonmetastatic RPS undergoing curative intent resection. Tumor size was dichotomized at 15 cm based on 8th edition American Joint Committee on Cancer (AJCC) staging. Patients with the highest comorbidity score were excluded. Unadjusted Kaplan-Meier and adjusted Cox proportional hazards modeling analyzed overall survival (OS). Multivariable logistic regression modeled margin positivity. A total of 2,264 patients were included; 727 patients (32.1%) had perioperative radiation in whom 203 (9.0%) had radiation preoperatively. Median (IQR) RPS size was 17.5 [11.0-27.0] cm. Histopathology was high grade in 1048 patients (43.7%). Multivariable analysis revealed that perioperative radiation was independently associated with decreased mortality (HR 0.72, 95% confidence intervals (CIs) 0.62-0.84, < 0.001), and preoperative RT was associated with reduced margin positivity (HR 0.72, 95% CI 0.53-0.97, =0.032). Stratified survival analysis showed that radiation was associated with prolonged median OS for RPS that were high-grade (64.3 vs. 43.6 months, < 0.001), less than 15 cm (104.1 vs. 84.2 months, =0.007), and leiomyosarcomatous (104.8 vs. 61.8 months, < 0.001). Perioperative radiation is independently associated with decreased mortality in patients with high-grade, less than 15 cm, and leiomyosarcomatous tumors. Preoperative radiation is independently associated with margin-negative resection. These data support the selective use of perioperative radiation in the multidisciplinary management of RPS.
围手术期放射治疗（RT）与腹膜后肉瘤（RPS）患者局部复发率降低相关；然而，选择标准仍不明确。我们假设围手术期放疗可提高RPS患者的生存率，并与病理因素相关。对2004年至2012年国家癌症数据库（NCDB）中接受根治性切除的非转移性RPS患者进行了回顾。根据美国癌症联合委员会（AJCC）第8版分期，将肿瘤大小在15cm处进行二分法划分。排除合并症评分最高的患者。采用未调整的Kaplan-Meier法和调整后的Cox比例风险模型分析总生存期（OS）。多变量逻辑回归对切缘阳性进行建模。共纳入2264例患者；727例患者（32.1%）接受了围手术期放疗，其中203例（9.0%）术前接受了放疗。RPS大小的中位数（IQR）为17.5[11.0-27.0]cm。1048例患者（43.7%）组织病理学为高级别。多变量分析显示，围手术期放疗与死亡率降低独立相关（HR 0.72，95%置信区间（CI）0.62-0.84，P<0.001），术前放疗与切缘阳性率降低相关（HR 0.72，95%CI 0.53-0.97，P=0.032）。分层生存分析显示，放疗与高级别RPS（64.3个月对43.6个月，P<0.001）、小于15cm（104.1个月对84.2个月，P=0.007）和平滑肌肉瘤（104.8个月对61.8个月，P<0.001）的中位OS延长相关。围手术期放疗与高级别、小于15cm和平滑肌肉瘤肿瘤患者的死亡率降低独立相关。术前放疗与切缘阴性切除独立相关。这些数据支持在RPS的多学科管理中选择性使用围手术期放疗。
