Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Sarcoma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Ann Surg Oncol. 2023 Jul;30(7):4500-4510. doi: 10.1245/s10434-023-13314-9. Epub 2023 Mar 17.
The extent of histological organ involvement (HOI) to organs and structures of a retroperitoneal liposarcoma may have prognostic implications. This study investigated incidence, characteristics, and risk association of HOI in these patients.
Data of patients who underwent multivisceral resection for primary liposarcoma (2009-2014) were retrospectively analyzed. HOI was the variable of interest and was classified into four degrees: absent (HOI-0), perivisceral (HOI-1), initial (HOI-2), and advanced (HOI-3). Primary endpoint was overall survival (OS). Secondary endpoint was disease-free survival (DFS). The prognostic value of HOI was adjusted for preoperative treatment and the Sarculator nomogram score.
A total of 109 patients were included. HOI-0, HOI-1, HOI-2, and HOI-3 were detected in 9 (8.3%), 11 (10.1%), 43 (39.4%), and 46 (42.2%) patients. Median follow-up was 8.4 years [interquartile range (IQR) 7.2-9.6 years]. There were 68 recurrences and 50 patient deaths observed, resulting in a 10-year OS and DFS of 51.1% [95% confidence interval (CI) 41.9-62.1%] and 34.1% (95% CI 25.2-46.1%), respectively. Clinically relevant HOIs (HOI-2 and HOI-3) were found in 35/45 (77.8%) and 54/64 (84.4%) cases of well- and de-differentiated liposarcomas, respectively. On multivariable survival analysis, patients with HOI-3 had significantly shorter OS (HOI-3 vs HOI-0/HOI-1 HR 2.92; p = 0.012) and DFS (HOI-3 vs HOI-0/HOI-1 HR 2.23; p = 0.045), independently of the nomogram score (OS: HR 2.93; p < 0.001; DFS: HR 1.78; p = 0.003).
Initial and advanced HOIs are frequently detected in both well-differentiated and de-differentiated liposarcomas, supporting that multivisceral resection may be needed. HOI stratifies the risk of patients with primary retroperitoneal liposarcoma.
腹膜后脂肪肉瘤的组织器官受累程度（HOI）可能与器官和结构有关，具有预后意义。本研究调查了这些患者HOI 的发生率、特征和风险关联。
回顾性分析了 2009-2014 年间接受多脏器切除术的原发性脂肪肉瘤患者的数据。HOI 是感兴趣的变量，分为四个等级：无（HOI-0）、腹膜旁（HOI-1）、初始（HOI-2）和高级（HOI-3）。主要终点是总生存（OS）。次要终点是无病生存（DFS）。HOI 的预后价值根据术前治疗和 Sarculator 列线图评分进行调整。
共纳入 109 例患者。9 例（8.3%）、11 例（10.1%）、43 例（39.4%）和 46 例（42.2%）患者分别检测到 HOI-0、HOI-1、HOI-2 和 HOI-3。中位随访时间为 8.4 年[四分位间距（IQR）为 7.2-9.6 年]。观察到 68 例复发和 50 例患者死亡，导致 10 年 OS 和 DFS 分别为 51.1%（95%CI 41.9-62.1%）和 34.1%（95%CI 25.2-46.1%）。在 well-differentiated 和 dedifferentiated 脂肪肉瘤中，分别在 35/45（77.8%）和 54/64（84.4%）例中发现了具有临床意义的 HOI（HOI-2 和 HOI-3）。多变量生存分析显示，HOI-3 患者的 OS（HOI-3 与 HOI-0/HOI-1 HR 2.92；p=0.012）和 DFS（HOI-3 与 HOI-0/HOI-1 HR 2.23；p=0.045）明显缩短，独立于列线图评分（OS：HR 2.93；p<0.001；DFS：HR 1.78；p=0.003）。
在 well-differentiated 和 dedifferentiated 脂肪肉瘤中均经常检测到初始和高级 HOI，支持需要进行多脏器切除术。HOI 可对原发性腹膜后脂肪肉瘤患者的风险进行分层。
