Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Department of Surgery A, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Ann Surg Oncol. 2019 Oct;26(11):3535-3541. doi: 10.1245/s10434-019-07615-1. Epub 2019 Jul 16.
Retroperitoneal sarcomas (RPS) lie in the retroperitoneal space and are covered by a peritoneal layer. However, some RPS have an intraperitoneal component (IPC), which invades into the peritoneal cavity. The significance of such a clinical presentation is unknown.
We retrospectively analyzed our prospectively maintained institutional database of RPS, along with intraoperative photographs taken to document the primary tumor extent at laparotomy. The effects of IPC on overall survival (OS), local recurrence (LR), and distant metastasis (DM) were evaluated.
IPC was present in 81 of 493 patients (16.4%). It was significantly associated with older age (64 vs. 59, p = 0.008), gender (67% vs. 33% males, p = 0.005), and multifocality (11.1% vs. 0.5%; p < 0.0001). IPC was not associated with size or any specific histology, while it showed a weak association with high malignancy grade (40.7% vs. 28.6% in G3 tumors; p = 0.076). At a median follow-up of 32 months IPC was associated with worse 5-year OS (54% vs. 74%, p < 0.001) and crude cumulative incidence (CCI) of LR (5-year CCI of LR: 38% vs. 19%, p = 0.001), but not to CCI of DM. However, multivariable models showed that IPC's effect on OS (HR: 1.52, 95% CI 0.92-2.49, p = 0.1) and LR (HR: 1.34, 95% CI 0.8-2.26, p = 0.27) could be sufficiently explained by other known risk factors.
IPC is associated with increased LR and decreased survival. However, the effect of IPC on prognosis is predominantly related to other tumor characteristics already included in published nomograms. IPC should not be a contraindication to a proper surgical resection.
腹膜后肉瘤（RPS）位于腹膜后间隙，由腹膜层覆盖。然而，有些 RPS 具有腹膜内成分（IPC），它侵犯到腹腔。这种临床表现的意义尚不清楚。
我们回顾性分析了我们前瞻性维护的 RPS 机构数据库，以及剖腹手术时拍摄的记录原发性肿瘤范围的术中照片。评估 IPC 对总生存（OS）、局部复发（LR）和远处转移（DM）的影响。
493 例患者中有 81 例（16.4%）存在 IPC。IPC 与年龄较大（64 岁比 59 岁，p=0.008）、性别（67%比 33%为男性，p=0.005）和多发性（11.1%比 0.5%；p<0.0001）显著相关。IPC 与肿瘤大小或任何特定组织学无关，但与高恶性程度有弱相关性（G3 肿瘤中为 40.7%比 28.6%；p=0.076）。在中位数为 32 个月的随访中，IPC 与较差的 5 年 OS（54%比 74%，p<0.001）和未经校正的 LR 累积发生率（5 年 LR 累积发生率：38%比 19%，p=0.001）相关，但与 DM 的累积发生率无关。然而，多变量模型显示，IPC 对 OS（HR：1.52，95%CI 0.92-2.49，p=0.1）和 LR（HR：1.34，95%CI 0.8-2.26，p=0.27）的影响可以被其他已知的风险因素充分解释。
IPC 与 LR 增加和生存率降低相关。然而，IPC 对预后的影响主要与已包含在发表的列线图中的其他肿瘤特征有关。IPC 不应成为适当手术切除的禁忌症。
