Wilhelm Alexander, Wiesler Benjamin, Kümmerli Christoph, Gross Markus W, Kettelhack Christoph, Müller Beat P
Department of Surgery, Clarunis - St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
Surgical Outcome Research Center Basel, University Hospital Basel, University Basel, Basel, Switzerland.
Ann Surg Oncol. 2025 Mar;32(3):1541-1549. doi: 10.1245/s10434-024-16703-w. Epub 2024 Dec 16.
The impact of radiotherapy on the oncologic outcome of retroperitoneal liposarcoma (RPLS) remains controversial. The aim of this study was to evaluate the effect of radiotherapy on disease-specific survival (DSS) in a cohort of patients with RPLSs.
In this population-based, retrospective cohort study, patients with localized RPLSs who underwent surgical therapy were identified from the Surveillance, Epidemiology, and End Results-17 cancer registry program. After propensity-score matching for potential confounders, multivariable logistic and Cox regression analyses were used to examine factors associated with DSS and radiotherapy.
From 2004 to 2020, 1692 patients with localized RPLS who underwent surgical therapy were identified (84.2% White, 44.6% female, mean age 62 years). Of those patients, 393 patients (23.2%) received perioperative radiotherapy. Patients who received radiotherapy had a higher rate of tumor size between 10 and 20 cm and unknown tumor grading. After propensity-score matching, multivariable adjusted Cox regression and Kaplan-Meier survival analysis demonstrated no improvement of DSS for patients who underwent radiotherapy (hazard ratio 1.04, confidence interval 0.81-1.32; log-rank p = 0.47). Patient age ≥80 years, larger tumor size, and tumor grading G3 versus G1/2 were associated with an increased risk of death due to RPLS. Subgroup analyses stratified by grading showed similar outcomes.
The administration of perioperative radiotherapy did not improve DSS in patients undergoing surgery for localized RPLS in this population-based study. Therefore, the use of perioperative radiotherapy in these patients may be questioned. However, the findings should be interpreted with caution due to the inherent limitations of the Surveillance, Epidemiology, and End Results (SEER) database.
放射治疗对腹膜后脂肪肉瘤（RPLS）肿瘤学结局的影响仍存在争议。本研究的目的是评估放射治疗对一组RPLS患者疾病特异性生存（DSS）的影响。
在这项基于人群的回顾性队列研究中，从监测、流行病学和最终结果-17癌症登记项目中识别出接受手术治疗的局限性RPLS患者。在对潜在混杂因素进行倾向评分匹配后，采用多变量逻辑回归和Cox回归分析来检查与DSS和放射治疗相关的因素。
2004年至2020年，共识别出1692例接受手术治疗的局限性RPLS患者（84.2%为白人，44.6%为女性，平均年龄62岁）。其中，393例患者（23.2%）接受了围手术期放射治疗。接受放射治疗的患者肿瘤大小在10至20 cm之间的比例较高，且肿瘤分级未知。倾向评分匹配后，多变量调整的Cox回归和Kaplan-Meier生存分析显示，接受放射治疗的患者DSS没有改善（风险比1.04，置信区间0.81-1.32；对数秩p = 0.47）。患者年龄≥80岁、肿瘤体积较大以及肿瘤分级为G3而非G1/2与RPLS导致的死亡风险增加相关。按分级分层的亚组分析显示了相似的结果。
在这项基于人群的研究中，围手术期放射治疗并未改善接受手术治疗的局限性RPLS患者的DSS。因此，这些患者围手术期放射治疗的使用可能受到质疑。然而，由于监测、流行病学和最终结果（SEER）数据库的固有局限性，这些发现应谨慎解释。
