Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Padova, Italy.
Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Padova, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padova, Italy.
Eur J Surg Oncol. 2021 May;47(5):1201-1206. doi: 10.1016/j.ejso.2020.08.030. Epub 2020 Sep 9.
Locoregional recurrence after resection of primary retroperitoneal sarcoma (RPS) is a challenging therapeutic issue. The objective of this study was to identify clinicopathological factors predictive of overall survival (OS) and disease specific survival (DSS) after reoperation for recurrent RPS.
We retrospectively collected data from the medical records of 800 patients who underwent resection for sarcoma at our Institution, from 1983 to 2015. Among these patients, 120 were treated for retroperitoneal sarcoma and 55 had a locoregional recurrence (LR). Four of them did not undergo surgery and thus were excluded from this study leaving 51 cases available for data analysis. Univariate and multivariate survival analyses were performed to identify prognostic factors.
Median overall survival was 33 months. The 1-year, 3-year and 5-year OS rates were 75.5%, 47.1% and 31.6% respectively. Multivariate Cox regression analysis suggested that extension of surgery (P = 0.026), surgical margin status (P = 0.015) and histological grade of recurrent tumor (P = 0.047) were independent prognostic factors for OS. Median DSS was 48 months. The 1-year, 3-year and 5-year DSS rates were 79.2%, 53.1% and 40.9%, respectively. At multivariate analysis, predictors of DSS were extension of surgery (P = 0.004), margin status (P = 0.011), histological grade of recurrent tumor (P = 0.008), and disease free interval (DFI) (P = 0.020). As regards histological subtype of recurrent RPS, at univariate analysis, well-differentiated liposarcoma (WDLS) was associated with better OS and DSS (P = 0.052 and P = 0.016 respectively) compared to dedifferentiated liposarcoma (DDLS).
According to our findings, surgery is more beneficial in patients with low-grade sarcoma, WDLS and long DFI. The achievement of clear resection margins, rather than performing a multivisceral resection, appears to be a key factor to improve OS and DSS.
原发性腹膜后肉瘤（RPS）切除术后局部复发是一个具有挑战性的治疗问题。本研究的目的是确定与再次手术治疗复发性 RPS 后总生存（OS）和疾病特异性生存（DSS）相关的临床病理因素。
我们回顾性地收集了自 1983 年至 2015 年在我院接受肉瘤切除术的 800 名患者的病历数据。其中 120 例患者为腹膜后肉瘤患者，55 例患者发生局部区域复发（LR）。其中 4 例患者未接受手术，因此被排除在本研究之外，最终 51 例患者纳入数据分析。采用单因素和多因素生存分析确定预后因素。
中位 OS 为 33 个月。1 年、3 年和 5 年 OS 率分别为 75.5%、47.1%和 31.6%。多因素 Cox 回归分析表明，手术范围（P=0.026）、手术切缘状态（P=0.015）和复发性肿瘤的组织学分级（P=0.047）是 OS 的独立预后因素。中位 DSS 为 48 个月。1 年、3 年和 5 年 DSS 率分别为 79.2%、53.1%和 40.9%。多因素分析表明，影响 DSS 的因素包括手术范围（P=0.004）、切缘状态（P=0.011）、复发性肿瘤的组织学分级（P=0.008）和无病间隔（DFI）（P=0.020）。对于复发性 RPS 的组织学亚型，单因素分析表明，与去分化脂肪肉瘤（DDLS）相比，高分化脂肪肉瘤（WDLS）的 OS 和 DSS 更好（P=0.052 和 P=0.016）。
根据我们的发现，对于低级别肉瘤、WDLS 和较长 DFI 的患者，手术更有益。实现清晰的切除边界，而不是进行多脏器切除，似乎是改善 OS 和 DSS 的关键因素。
