Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Department of Medical Statistics, Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Ann Surg Oncol. 2021 Nov;28(12):7939-7949. doi: 10.1245/s10434-021-10059-1. Epub 2021 May 12.
Correlations between postoperative complications and oncological outcomes have been reported in several malignancies, but their impact in retroperitoneal sarcoma (RPS) is unclear. Our study aimed to evaluate the association between postoperative complications and prognosis in patients with RPS.
Patients undergoing surgery for primary RPS from 2008 to 2019 at a sarcoma center were evaluated. The cumulative burden of postoperative complications was quantified using the Comprehensive Complication Index (CCI), and associations with local recurrence (LR), distant metastases (DM) and overall survival (OS) were assessed.
Data were available for 191 patients, of whom 160 (82.9%) developed at least one postoperative complication, with a median CCI of 20.9 (interquartile range 8.7-33.5). After postoperative deaths were excluded (n = 3, 1.6%), the remaining patients were divided into those with a CCI of 0-20.9 (n = 97) and > 20.9 (n = 91). Patients with a CCI >20.9 had significantly shorter OS than those with a CCI of 0-20.9 (43.3% vs. 69.5% at 5 years; p = 0.005), and this difference remained significant after multivariable adjustment for patient- and treatment-related factors [hazard ratio (HR) 2.31, 95% confidence interval (CI) 1.30-4.09; p = 0.004]. However, CCI > 20.9 was not found to be a significant independent predictor of either LR (HR 1.30, 95% CI 0.76-2.23; p = 0.333) or DM (HR 1.08, 95% CI 0.61-1.93; p = 0.786).
Increasing complication burden, as quantified by the CCI, is a significant independent predictor of OS; however, there is no evidence of a significant association with either LR or DM, which may be more related to tumor biological factors.
术后并发症与多种恶性肿瘤的肿瘤学结局之间存在相关性，但在腹膜后肉瘤（RPS）中其影响尚不清楚。我们的研究旨在评估 RPS 患者术后并发症与预后之间的关系。
评估了 2008 年至 2019 年在肉瘤中心接受原发性 RPS 手术的患者。使用综合并发症指数（CCI）量化术后并发症的累积负担，并评估其与局部复发（LR）、远处转移（DM）和总生存（OS）的关系。
191 例患者的数据可用，其中 160 例（82.9%）至少发生了一次术后并发症，CCI 中位数为 20.9（四分位距 8.7-33.5）。排除术后死亡（n=3，1.6%）后，将其余患者分为 CCI 为 0-20.9（n=97）和>20.9（n=91）两组。CCI>20.9 的患者 OS 明显短于 CCI 为 0-20.9 的患者（5 年时分别为 43.3%和 69.5%；p=0.005），并且在校正患者和治疗相关因素后，这种差异仍然显著[风险比（HR）2.31，95%置信区间（CI）1.30-4.09；p=0.004]。然而，CCI>20.9 并未被发现是 LR（HR 1.30，95% CI 0.76-2.23；p=0.333）或 DM（HR 1.08，95% CI 0.61-1.93；p=0.786）的独立预测因子。
CCI 量化的并发症负担增加是 OS 的显著独立预测因子；然而，没有证据表明与 LR 或 DM 有显著相关性，这可能与肿瘤生物学因素更为相关。
