Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA.
Department of Sarcoma Medical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2021 Jan;28(1):570-575. doi: 10.1245/s10434-020-08582-8. Epub 2020 May 14.
Resection of recurrent retroperitoneal well-differentiated liposarcoma (RP-WDLPS) is unlikely to result in cure. Thus, most clinicians delay surgery after recurrence until symptom intolerance or increasing rate of disease progression. The aim of this study was to determine whether longer surveillance intervals in this population would impact outcomes or delay treatment in those who recur.
A retrospective review of patients with primary RP-WDLPS who underwent resection between April 1996 and April 2017 and surveillance at MDACC (n = 91) was performed.
Median age at diagnosis of primary RP-WDLPS was 61 years; median tumor size was 30 cm. Complete resection was achieved in 85 (93.4%) patients. Among patients who underwent complete resection, recurrence occurred in 53 (60.2%) with median time to recurrence of 27.0 months. Thirty-six (69.6%) of these patients underwent resection of recurrent disease at a median 40.2 months from primary tumor resection. Surveillance imaging at 4-month (vs 3-month) intervals would not have impacted recurrence management in 84 (95.5%) patients; imaging at 6-month (vs 3-month) intervals would not have impacted management of recurrence in 80 (90.9%).
Recurrence was common, often occurring beyond the early postoperative period following primary RP-WDLPS resection. More frequent surveillance imaging (q3-4 vs q6 months) in the first 2 years following primary RP-WDLPS resection may not significantly impact timing of surgery or systemic therapy for recurrence. If longer surveillance intervals were shown to be safe with equivalent outcomes in prospective studies, the resulting change in practice could lead to decreased anxiety and cost for patients and healthcare systems.
复发性腹膜后高分化脂肪肉瘤（RP-WDLPS）的切除不太可能治愈。因此，大多数临床医生在复发后会延迟手术，直到出现症状不耐受或疾病进展速度加快。本研究旨在确定在该人群中，更长的监测间隔是否会影响结果，或者是否会延迟复发患者的治疗。
对 1996 年 4 月至 2017 年 4 月期间在 MDACC 接受 RP-WDLPS 原发性切除术并进行监测的患者进行了回顾性分析（n=91）。
原发性 RP-WDLPS 的诊断中位年龄为 61 岁；肿瘤中位大小为 30cm。85 例（93.4%）患者实现了完全切除。在完全切除的患者中，53 例（60.2%）发生复发，复发中位时间为 27.0 个月。其中 36 例（69.6%）患者在原发性肿瘤切除后 40.2 个月行复发性疾病切除术。如果在 4 个月（而非 3 个月）间隔进行监测成像，不会对 84 例（95.5%）患者的复发管理产生影响；如果在 6 个月（而非 3 个月）间隔进行监测成像，不会对 80 例（90.9%）患者的复发管理产生影响。
复发性疾病很常见，常在原发性 RP-WDLPS 切除后的早期术后阶段发生。在原发性 RP-WDLPS 切除后最初 2 年内，更频繁的监测成像（q3-4 与 q6 个月）可能不会显著影响手术或复发性疾病的系统治疗时机。如果前瞻性研究表明更长的监测间隔是安全的，且结果与当前实践等效，则实践中的这一变化可能会降低患者和医疗体系的焦虑和成本。
