Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Osaka, 541-8567, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan.
World J Surg Oncol. 2024 Oct 5;22(1):265. doi: 10.1186/s12957-024-03552-w.
Retroperitoneal dedifferentiated liposarcoma is associated with a high risk of recurrence; however, treatment strategies that are more effective than surgery remain to be established. This study aimed to determine the optimal number of surgeries that would be effective for patients with recurrent disease. Furthermore, the improvement in prognosis was evaluated according to the malignancy level.
The effect of each type of surgery on the prognosis of 118 patients with retroperitoneal dedifferentiated liposarcoma treated at the Osaka International Cancer Institute between 1997 and 2022 was investigated. Among the 118 patients, 103 underwent initial surgery, while 54 and 30 patients underwent second and third surgeries, respectively. The overall and disease-free survival rates of each group were compared using the Kaplan-Meier method, and the log-rank test was used to determine statistical significance in univariate analysis. F-Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) was used to assess malignancy. Maximum standardized uptake values (SUVmax) of ≥ 4 and < 4 were classified as high and low malignancy, respectively.
The first and second surgeries resulted in a significant improvement in the overall survival rate, regardless of the malignancy level (p < 0.001); however, no significant improvement in prognosis was observed after the third surgery (p = 0.077). Low-grade malignancies are associated with a better postoperative prognosis, even in cases of recurrence. In contrast, high-grade malignancies exhibit a reduction in surgical efficacy.
This study highlights the importance of considering the tumor malignancy level and the patient's overall condition when deciding whether to perform repeated surgical interventions. Surgical treatment can prolong overall survival, even in patients with recurrence; however, it is advisable to assess malignancy levels when determining the suitability of surgery beyond the second recurrence.
腹膜后去分化脂肪肉瘤复发风险高，但仍需确立比手术更有效的治疗策略。本研究旨在确定对复发性疾病患者有效的最佳手术次数。此外，根据恶性程度评估预后的改善情况。
研究分析了 1997 年至 2022 年期间在大阪国际癌症研究所接受治疗的 118 例腹膜后去分化脂肪肉瘤患者的每种手术类型对其预后的影响。在这 118 例患者中，103 例患者接受了初始手术，54 例和 30 例患者分别接受了二次和三次手术。使用 Kaplan-Meier 方法比较每组的总生存率和无病生存率，单因素分析采用对数秩检验确定统计学意义。氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）用于评估恶性程度。最大标准化摄取值（SUVmax）≥4 和＜4 分别归类为高恶性和低恶性。
无论恶性程度如何，第一次和第二次手术均显著改善了总生存率（p＜0.001）；然而，第三次手术后预后无显著改善（p＝0.077）。低级别恶性肿瘤即使在复发的情况下，术后预后也较好。相比之下，高级别恶性肿瘤会降低手术效果。
本研究强调了在决定是否进行重复手术干预时，应考虑肿瘤恶性程度和患者的整体状况。手术治疗可延长总生存期，即使是在复发患者中；然而，在确定第二次复发后的手术适宜性时，评估恶性程度是很有必要的。
