MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC.
MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Hyattsville, MD.
Surgery. 2020 Nov;168(5):831-837. doi: 10.1016/j.surg.2020.05.031. Epub 2020 Jul 21.
Given the rarity of retroperitoneal soft tissue sarcoma, few studies have assessed if radical excision of retroperitoneal soft tissue sarcoma with adjacent organs improves survival outcomes. This propensity score-matched study aimed to evaluate the impact of radical excision versus resection of tumor alone.
The National Cancer Database 2004 to 2015 was used to assess short- and long-term outcomes of resection of tumor alone versus radical excision (tumor plus ≥1 adjacent organs) via 1:1 propensity-matched analyses. Subgroup analyses included low-grade, high-grade, liposarcoma, leiomyosarcoma, adjacent organ involvement alone, localized tumors alone, and high-volume hospitals (≥10 resections/y). Multivariable logistic regression models identified factors associated with radical excision.
Comparison of propensity-matched groups (N = 1,139/group) revealed no significant differences in 30-day mortality, 90-day mortality, or overall survival (for all, P > .580). For all subgroup analyses comparing resection of tumor alone with radical excision, including localized tumors without organ invasion (N = 208/group), there were no identified differences in short- or long-term survival. Although it yielded lower R2 resection rates (P = .007), radical excision was associated with greater mean length of stay (P < .001).
Radical excision was not associated with improved retroperitoneal soft tissue sarcoma survival irrespective of grade, histology, hospital volume, or adjacent organ involvement. Resection of ostensibly involved adjacent viscera may increase morbidity without survival benefit. These results inform ongoing discussion regarding histology-tailored, situation-specific extent of retroperitoneal soft tissue sarcoma resections.
鉴于腹膜后软组织肉瘤的罕见性，很少有研究评估腹膜后软组织肉瘤联合相邻器官的根治性切除是否能改善生存结果。本倾向评分匹配研究旨在评估根治性切除与单纯肿瘤切除术的影响。
使用国家癌症数据库 2004 年至 2015 年的数据，通过 1:1 倾向评分匹配分析评估单纯肿瘤切除术与根治性切除术（肿瘤加≥1 个相邻器官）的短期和长期结果。亚组分析包括低级别、高级别、脂肪肉瘤、平滑肌肉瘤、单独相邻器官受累、局限性肿瘤和高容量医院（≥10 例/年）。多变量逻辑回归模型确定了与根治性切除相关的因素。
对倾向评分匹配组（每组 N=1139）的比较显示，30 天死亡率、90 天死亡率或总生存率（所有 P>.580）无显著差异。对于所有比较单纯肿瘤切除术与根治性切除术的亚组分析，包括无器官侵犯的局限性肿瘤（每组 N=208），短期或长期生存均无差异。尽管根治性切除的 R2 切除率较低（P=.007），但平均住院时间更长（P<.001）。
无论组织学分级、组织学类型、医院容量或相邻器官受累情况如何，根治性切除与腹膜后软组织肉瘤的生存改善均无相关性。切除明显受累的相邻内脏可能会增加发病率，而没有生存获益。这些结果为正在进行的关于基于组织学的、具体情况的腹膜后软组织肉瘤切除范围的讨论提供了信息。
