Matsui Yoshiyuki, Iwata Shintaro, Moritani Konosuke, Maejima Aiko, Nara Satoshi, Yamagata Yukinori, Komiyama Motokiyo, Kamio Satoshi, Yonemori Kan, Kawai Akira, Fujimoto Hiroyuki
Department of Urology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan.
Int J Clin Oncol. 2025 May 28. doi: 10.1007/s10147-025-02790-6.
This study aimed to identify prognostic factors and treatment patterns at the first recurrence of retroperitoneal liposarcoma (LPS).
Medical records of 150 patients who underwent resection for primary retroperitoneal LPS were reviewed. Of the 94 patients with local or distant recurrence, prognostic factors and treatment approaches were retrospectively analyzed.
At recurrence, 41 patients underwent surgery, 12 received radiation, 23 received chemotherapy, 12 were under active surveillance, and 6 received best supportive care. In univariate analysis, well-differentiated primary tumors predicted better overall survival (OS) compared to dedifferentiated tumors (p = 0.004). Conversely, shorter recurrence-free survival (RFS) after initial surgery, smaller recurrent tumors at treatment, and high neutrophil-to-lymphocyte ratio (NLR) at recurrence were associated with poorer OS (p = 0.0418, 0.007, and 0.0475, respectively). Treatment decisions were influenced by RFS, time from recurrence to treatment, initial tumor differentiation, recurrence site, and multiplicity. Among those who had surgery for recurrence, 29.2% (12/41) showed a change in tumor differentiation. RFS was a significant predictor of this change (p = 0.026). Additionally, NLR at recurrence and the waiting period from recurrence to treatment were significant prognostic factors in surgically treated patients (p = 0.005 and 0.028, respectively).
RFS, timing of treatment, initial tumor differentiation, and recurrence characteristics influence treatment choices at first recurrence. RFS may predict changes in tumor differentiation, while NLR at recurrence and the waiting period from recurrence to treatment are important prognostic indicators in patients undergoing surgery.
本研究旨在确定腹膜后脂肪肉瘤（LPS）首次复发时的预后因素及治疗模式。
回顾了150例接受原发性腹膜后LPS切除术患者的病历。对94例出现局部或远处复发的患者，回顾性分析其预后因素及治疗方法。
复发时，41例患者接受了手术，12例接受了放疗，23例接受了化疗，12例接受积极监测，6例接受最佳支持治疗。单因素分析显示，与去分化肿瘤相比，高分化原发性肿瘤的总生存期（OS）更佳（p = 0.004）。相反，初次手术后无复发生存期（RFS）较短、治疗时复发肿瘤较小以及复发时中性粒细胞与淋巴细胞比值（NLR）较高与较差的OS相关（分别为p = 0.0418、0.007和0.0475）。治疗决策受RFS、复发至治疗的时间、初始肿瘤分化、复发部位和肿瘤数量的影响。在因复发接受手术的患者中，29.2%（12/41）的肿瘤分化发生了变化。RFS是这种变化的显著预测因素（p = 0.026）。此外，复发时的NLR以及复发至治疗的等待期是手术治疗患者的重要预后因素（分别为p = 0.005和0.028）。
RFS、治疗时机、初始肿瘤分化和复发特征会影响首次复发时的治疗选择。RFS可能预测肿瘤分化的变化，而复发时的NLR以及复发至治疗的等待期是接受手术患者的重要预后指标。
