Murphy Skyle, Allan Christopher, Barbour Andrew, Donoghue Victoria, Smithers B Mark
Princess Alexandra Hospital, Brisbane, QLD 4102, Australia.
School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia.
Curr Oncol. 2025 Jun 19;32(6):364. doi: 10.3390/curroncol32060364.
For patients with retroperitoneal sarcomas (RPSs), en-bloc resection with macroscopically negative margins remains the only potentially curative treatment. Textbook outcomes (TOs) are composite measures developed to compare ideal surgical outcomes for complex oncologic resections. The aims of this study were as follows: to define TO for RPS resections; to investigate the impact of treating service and other variables on TO; and to investigate the impact of treating service on achieving a TO. Population-based data from the Queensland Oncology Repository (QOR) was used to perform a retrospective review of all adult patients who underwent resection for primary RPS in Queensland between 2012 and 2022. TO was defined as follows: en-bloc resection; macroscopically negative margins; no unplanned ICU admission, no Clavien-Dindo III or greater complications; hospital length of stay of 14 days or less; no readmission within 30 days; and no 90-day mortality. A TO was achieved in 82 (56.94%) of the 144 patients included in the study. A high-grade histological subtype, the resection of three or more contiguous organs, major vascular resection and treatment outside of a high-volume sarcoma centre (HVSC) were significant negative predictors of achieving TOs ( < 0.05). On multivariate analysis, treatment at a high-volume sarcoma centre was independently associated with a 2.6-fold increase in TO (1.18-5.88, = 0.02). Achieving a TO was associated with higher five-year DFS (61.5% vs. 41.3%, = 0.03) and OS (76% vs. 59.4%, = 0.02). In our state, TOs provide a measure of the quality of RPS resection across multiple health services, with patients treated at high-volume sarcoma centres more likely to achieve a TO. TO rates are associated with improved five-year DFS and OS.
对于腹膜后肉瘤（RPS）患者，实现宏观切缘阴性的整块切除仍然是唯一可能治愈的治疗方法。教科书式结局（TO）是为比较复杂肿瘤切除的理想手术结局而制定的综合指标。本研究的目的如下：定义RPS切除的TO；研究治疗机构及其他变量对TO的影响；研究治疗机构对实现TO的影响。利用昆士兰肿瘤登记库（QOR）的基于人群的数据，对2012年至2022年间在昆士兰接受原发性RPS切除的所有成年患者进行回顾性分析。TO定义如下：整块切除；宏观切缘阴性；无计划外入住重症监护病房，无Clavien-Dindo III级或更高级别的并发症；住院时间为14天或更短；30天内无再次入院；90天内无死亡。本研究纳入的144例患者中，82例（56.94%）实现了TO。高级别组织学亚型、三个或更多相邻器官的切除、主要血管切除以及在高容量肉瘤中心（HVSC）以外的机构接受治疗是实现TO的显著负性预测因素（<0.05）。多因素分析显示，在高容量肉瘤中心接受治疗与TO增加2.6倍独立相关（1.18 - 5.88，=0.02）。实现TO与更高的五年无病生存率（61.5%对41.3%，=0.03）和总生存率（76%对59.4%，=0.02）相关。在我们所在的州，TO提供了一种衡量多个医疗服务机构中RPS切除质量的指标，在高容量肉瘤中心接受治疗的患者更有可能实现TO。TO率与改善的五年无病生存率和总生存率相关。
