腹膜后脂肪肉瘤的病理预后因素：124例临床病理综合分析
Pathological prognostic factors of retroperitoneal liposarcoma: comprehensive clinicopathological analysis of 124 cases.
作者信息
Sun Pingping, Ma Ru, Liu Gang, Wang Lingling, Chang Hong, Li Yan
机构信息
Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
出版信息
Ann Transl Med. 2021 Apr;9(7):574. doi: 10.21037/atm-21-972.
BACKGROUND
Retroperitoneal liposarcoma (RLS) is a type of rare malignant tumor. The aim of the present study was to study the correlations between the clinicopathological characteristics and the prognostic factors of RLSso as to delineate independent pathological indicators affecting prognosis.
METHODS
The RLS pathological specimens were collected at Beijing Shijitan Hospital Affiliated to Capital Medical University from 2008 to 2018, and were used to study the histopathological features, including tumor size, histological types, lymphatic metastasis, tumor emboli in the blood and lymph vessels, and nerve invasion; immunohistochemical features, including Ki-67 and P53 proteins; and molecular pathological features, such as MDM2 (murine double minute2) gene amplification. Clinical treatment and follow-up data were collected, and the survival rate was calculated by Kaplan-Meier method. Univariate and multivariate survival analyses were performed to study the independent pathological factors.
RESULTS
Of the 124 RLS cases, 63 were males (50.8%) and 61 were females (49.2%), with a median age of 52 years (range, 22-80 years). There were 51 cases (41.1%) of well-differentiated liposarcoma, 73 cases (57.3%) of dedifferentiated liposarcoma (DDL); 3 cases (2.4%) with lymph node metastases; 4 cases (3.2%) with tumor emboli in the vessels; 21 cases (16.9%) with Ki-67 label index <20% and 103 cases (83.1%) with Ki-67 label index ≥20%; and 81 cases (65.3%) with P53 <60% and 43 cases (24.7%) with P53 ≥60%. Fluorescence hybridization studies revealed MDM2 gene amplification. Univariate analysis found the following pathological factors were correlated with prognosis: histopathological classification, recurrence, mitosis, tumor necrosis, Ki-67 label index, and P53. Multivariate analysis by Cox proportional hazard model found the following three independent pathological prognostic factors: age [hazard ratio (HR): 1.798, P=0.018], tumor site (HR: 1.263, P=0.002), tumor necrosis (HR: 1.984, P=0.024), and recurrence (HR: 2.161, P=0.049).
CONCLUSIONS
Age, tumor necrosis, tumor site, and recurrence could be independent pathological prognostic factors for RLS.
背景
腹膜后脂肪肉瘤（RLS）是一种罕见的恶性肿瘤。本研究旨在探讨RLS的临床病理特征与预后因素之间的相关性，以明确影响预后的独立病理指标。
方法
收集2008年至2018年首都医科大学附属北京世纪坛医院的RLS病理标本，用于研究组织病理学特征，包括肿瘤大小、组织学类型、淋巴结转移、血管内肿瘤栓子及神经侵犯；免疫组化特征，包括Ki-67和P53蛋白；以及分子病理特征，如MDM2（小鼠双微体2）基因扩增。收集临床治疗及随访数据，采用Kaplan-Meier法计算生存率。进行单因素和多因素生存分析以研究独立病理因素。
结果
124例RLS患者中，男性63例（50.8%），女性61例（49.2%），中位年龄52岁（范围22 - 80岁）。高分化脂肪肉瘤51例（41.1%），去分化脂肪肉瘤（DDL）73例（57.3%）；3例（2.4%）有淋巴结转移；4例（3.2%）有血管内肿瘤栓子；21例（16.9%）Ki-67标记指数<20%，103例（83.1%）Ki-67标记指数≥20%；81例（65.3%）P53<60%，43例（24.7%）P53≥60%。荧光杂交研究显示MDM2基因扩增。单因素分析发现以下病理因素与预后相关：组织病理学分类、复发、有丝分裂、肿瘤坏死、Ki-67标记指数和P53。Cox比例风险模型多因素分析发现以下三个独立的病理预后因素：年龄[风险比（HR）：1.798，P = 0.018]、肿瘤部位（HR：1.263，P = 0.002）、肿瘤坏死（HR：1.984，P = 0.024）和复发（HR：
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