Segu Hitha V, Rampam Sanjeev, Gonzalez Marcos R, Gebhardt Nicholas M, Chebib Ivan, Hung Yin P, Lozano-Calderon Santiago A
Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2025 Jun 9. doi: 10.1245/s10434-025-17606-0.
Atypical lipomatous tumors (ALTs) are lipomatous neoplasms of the trunk and extremities with higher local recurrence rate than lipomas. Although wide resection is no longer routinely performed, there remains considerable variability in the extent of tissue resection during marginal excision.
We retrospectively identified patients with histologically proven ALT of the trunk or extremities treated with surgery between 1993 and 2021. We compared wide resection, expanded marginal excision, and simple marginal excision. Expanded marginal excision involved the removal of tissue infiltrated by fat, which can include the fascia, epimysium, or even muscle if it was involved.
We included 105 patients with median follow-up of 5.5 years. Local recurrence occurred in 15 patients (14.3%). Dedifferentiation occurred in 13% of recurrent patients (2/15), and none of these metastasized. Five- and 10-year local recurrence-free survival (LRFS) were 88.6% and 75.6%, respectively, and did not improve with the use of radiation therapy (RT). Five-year LRFS was 100% for both wide resection and expanded marginal excision. When compared with simple marginal excision, expanded marginal excision showed a trend toward higher 5-year LRFS (100% vs. 86.9%, p = 0.2). Risk factors for local recurrence included sclerosing subtype (adjusted odds ratio (aOR) 5.47) and tumors with previous recurrence (aOR 4.92).
Expanded marginal excision showed noninferior local control rates to wide resection without the additional morbidity of the latter, while suggesting to be superior to simple marginal resection. Future investigations featuring longer follow-up times should compare long-term local control rates by use of RT, type of resection, and ALT subtype.
III.
非典型脂肪瘤性肿瘤（ALT）是发生于躯干和四肢的脂肪瘤性肿瘤，其局部复发率高于脂肪瘤。尽管广泛切除已不再常规进行，但在边缘切除过程中，组织切除范围仍存在很大差异。
我们回顾性纳入了1993年至2021年间接受手术治疗且经组织学证实为躯干或四肢ALT的患者。我们比较了广泛切除、扩大边缘切除和单纯边缘切除。扩大边缘切除包括切除被脂肪浸润的组织，如果累及筋膜、肌外膜甚至肌肉，也一并切除。
我们纳入了105例患者，中位随访时间为5.5年。15例患者（14.3%）出现局部复发。13%的复发患者（2/15）发生去分化，且均未发生转移。5年和10年局部无复发生存率（LRFS）分别为88.6%和75.6%，放疗（RT）并未改善这一结果。广泛切除和扩大边缘切除的5年LRFS均为100%。与单纯边缘切除相比，扩大边缘切除的5年LRFS有升高趋势（100%对86.9%，p = 0.2）。局部复发的危险因素包括硬化亚型（调整优势比[aOR] 5.47）和既往有复发史的肿瘤（aOR 4.92）。
扩大边缘切除显示出与广泛切除相当的局部控制率，且没有后者的额外并发症，同时提示其优于单纯边缘切除。未来随访时间更长的研究应比较放疗、切除类型和ALT亚型对长期局部控制率的影响。
III级
