Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Ann Surg Oncol. 2023 Oct;30(11):6886-6893. doi: 10.1245/s10434-023-13933-2. Epub 2023 Jul 24.
Management of retroperitoneal sarcoma (RPS) remains controversial, with the mainstay of treatment being surgery. While neoadjuvant radiation demonstrated no improvement in recurrence-free survival in a prospective randomized trial (STRASS), the role of neoadjuvant chemotherapy (NCT) remains unknown and is the subject of ongoing study (STRASS2).
Patients who underwent surgical resection of high-grade RP leiomyosarcoma (LMS) or dedifferentiated liposarcoma (DDLS) were identified from the National Cancer Database (2006-2019). Predictors of NCT were analyzed using univariate and multivariate logistic regression analyses. Differences in 5-year survival were examined using the Kaplan-Meier (KM) method and by Cox proportional hazard modeling.
A total of 2656 patients met inclusion criteria. Fifty-seven percent of patients had DDLS and 43.5% had LMS. Six percent of patients underwent NCT. Patients who received NCT were younger (median age 60 vs 64 years, p < 0.001) and more likely to have LMS (OR 1.4, p = 0.04). In comparing NCT with no-NCT patients, there was no difference in 5-year overall survival (OS) on KM analysis (57.3% vs 52.8%, p = 0.38), nor was any difference seen after propensity matching (54.9% vs 49.1%, p = 0.48, N = 144 per group). When stratified by histology, there was no difference in OS based on receipt of NCT (LMS: 59.8% for NCT group, 56.6% for no-NCT, p = 0.34; DDLS: 54.2% for NCT group, 50.1% for no-NCT, p = 0.99).
In patients undergoing surgical resection of RP LMS or DDLS, NCT does not appear to confer an OS advantage. Prospective randomized data from STRASS2 will confirm or refute these retrospective data.
腹膜后肉瘤（RPS）的治疗方法仍存在争议，主要治疗方法是手术。虽然在一项前瞻性随机试验（STRASS）中，新辅助放疗并未改善无复发生存率，但新辅助化疗（NCT）的作用仍不清楚，这也是正在进行的研究（STRASS2）的主题。
从国家癌症数据库（2006-2019 年）中确定接受高级别腹膜后平滑肌肉瘤（LMS）或去分化脂肪肉瘤（DDLS）手术切除的患者。使用单因素和多因素逻辑回归分析来分析 NCT 的预测因素。使用 Kaplan-Meier（KM）方法和 Cox 比例风险模型来检查 5 年生存率的差异。
共有 2656 名患者符合纳入标准。57%的患者患有 DDLS，43.5%的患者患有 LMS。有 6%的患者接受了 NCT。接受 NCT 的患者年龄更小（中位年龄 60 岁 vs 64 岁，p < 0.001），更有可能患有 LMS（OR 1.4，p = 0.04）。在比较接受 NCT 和未接受 NCT 的患者时，KM 分析显示 5 年总生存率（OS）没有差异（57.3% vs 52.8%，p = 0.38），在进行倾向匹配后也没有差异（54.9% vs 49.1%，p = 0.48，每组 144 人）。按组织学分层，根据接受 NCT 的情况，OS 无差异（LMS：NCT 组为 59.8%，无 NCT 组为 56.6%，p = 0.34；DDLS：NCT 组为 54.2%，无 NCT 组为 50.1%，p = 0.99）。
在接受腹膜后 LMS 或 DDLS 手术切除的患者中，NCT 似乎并不能带来 OS 优势。来自 STRASS2 的前瞻性随机数据将证实或反驳这些回顾性数据。
