Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
Ann Surg Oncol. 2023 Oct;30(11):6875-6883. doi: 10.1245/s10434-023-13754-3. Epub 2023 Jul 9.
Disease recurrence after retroperitoneal sarcoma (RPS) surgery is common, and resection may offer no benefit for patients who experience recurrence early. This study examined the incidence of early recurrence (EREC) in RPS patients, and the association between EREC and prognosis, aiming to identify the factors associated with EREC.
Patients undergoing surgery for primary RPS from 2008 to 2019 at two tertiary RPS centers were analyzed. The study defined EREC as any evidence of local recurrence and/or distant metastases on the CT scan up to 6 months after surgery. Overall survival (OS) was calculated using the Kaplan-Meier method. A multivariable analysis was performed to identify independent predictors of EREC.
Of the 692 patients who underwent surgery during the study period, 657 were included in the analysis. Sixty-five of these patients (9.9%; 95% confidence interval [CI], 7.7-12.4%) developed EREC. Five-year OS was 3% for the patients with EREC versus 76% for those without EREC (p < 0.001). Patient characteristics were compared between the EREC and non-EREC patients, and EREC was found to be significantly associated with Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.006), tumor histology (p = 0.002), tumor grading (p < 0.001), radiotherapy (p = 0.04), and postoperative complications measured as a comprehensive complications index value (p = 0.003). However, the only significant independent predictor of EREC in the multivariable analysis was grade 3 tumors, with an odds ratio of 14.8 (95% CI, 4.44-49.2; p < 0.001).
Early recurrence is associated with a poor prognosis, and a high tumor grade is an independent predictor for the development of EREC. Patients with EREC may benefit the most from new therapeutic options such as neoadjuvant chemotherapy.
腹膜后肉瘤（RPS）手术后疾病复发很常见，对于早期复发的患者，手术切除可能无益。本研究检查了 RPS 患者的早期复发（EREC）发生率，以及 EREC 与预后的关系，旨在确定与 EREC 相关的因素。
分析了 2008 年至 2019 年在两个三级 RPS 中心接受原发性 RPS 手术的患者。本研究将 EREC 定义为手术后 6 个月内 CT 扫描上局部复发和/或远处转移的任何证据。使用 Kaplan-Meier 方法计算总生存率（OS）。进行多变量分析以确定 EREC 的独立预测因素。
在研究期间接受手术的 692 名患者中，有 657 名被纳入分析。这些患者中有 65 名（9.9%；95%置信区间，7.7-12.4%）发生了 EREC。有 EREC 的患者 5 年 OS 为 3%，而无 EREC 的患者为 76%（p<0.001）。比较了 EREC 患者和非 EREC 患者的特征，发现 EREC 与东部肿瘤协作组（ECOG）表现状态（p=0.006）、肿瘤组织学（p=0.002）、肿瘤分级（p<0.001）、放疗（p=0.04）和术后并发症（综合并发症指数值，p=0.003）显著相关。然而，多变量分析中 EREC 的唯一显著独立预测因素是 3 级肿瘤，其优势比为 14.8（95%置信区间，4.44-49.2；p<0.001）。
早期复发与预后不良相关，高肿瘤分级是 EREC 发展的独立预测因素。发生 EREC 的患者可能最受益于新的治疗选择，如新辅助化疗。
