R0切除术后腹膜后脂肪肉瘤的预后因素：年龄、组织学类型、肿瘤分期及分化程度的研究
Prognostic factors in retroperitoneal liposarcoma after R0 resection: a study of age, histologic type, tumor stage, and differentiation grade.
作者信息
Zou Boyuan, Chen Xiaobing, Gao Haicheng, Liu Shibo, Li Wenjie, Ye Yingjiang
机构信息
Department of Gastrointestinal Surgery, Peking University People's Hospital Beijing 100044, China.
Department of Retroperitoneal Tumor and Anorectal Surgery, Peking University International Hospital Beijing 100044, China.
出版信息
Am J Transl Res. 2025 Aug 15;17(8):5975-5986. doi: 10.62347/FQAD9826. eCollection 2025.
OBJECTIVE
This study aimed to identify prognostic factors affecting progression-free survival (PFS) in patients with retroperitoneal liposarcoma (RPLS) after R0 resection.
METHODS
A retrospective analysis was conducted on 183 RPLS patients who underwent R0 resection, evaluating general information, clinicopathological data, laboratory parameters, and follow-up outcomes. Based on follow-up outcomes, patients were categorized into progression-free survival (PFS) group (PFS, n=121) and disease progression group (DP, n=62). The general information, clinicopathological data, and laboratory parameters of the two groups were systematically compared, with statistically significant factors subsequently incorporated into the Cox multivariate regression analysis. Significant prognostic factors identified through Cox analysis were further evaluated using Kaplan-Meier (K-M) survival analysis, serving as the foundation for constructing the predictive model. The model's performance was rigorously assessed for 1-year, 3-year, and overall PFS prediction.
RESULTS
Multivariate analysis identified age (=1.034, 95% CI=1.011-1.057, =0.003), histologic subtype (Well-differentiated liposarcoma as reference. Dedifferentiated liposarcoma: =0.130, 95% CI=0.029-0.578, =0.007. Myxoid/round cell liposarcoma: =0.190, 95% CI=0.084-1.635, =0.190. Pleomorphic liposarcoma: =0.176, 95% CI=0.036-0.865, =0.032. Mixed-type liposarcoma: =0.793, 95% CI=0.157-4.008, =0.799), tumor stage (=0.440, 95% CI=0.257-0.755, =0.003), and tumor differentiation grade (=0.395, 95% CI=0.236-0.661, <0.001) as independent risk factors. The predictive models demonstrated excellent discriminative ability: 1-year model (AUC=0.944, NB=0.05-0.80), 3-year model (AUC=0.861, NB=0.05-0.73), the overall mode (AUC=0.903, NB=0.03-0.90).
CONCLUSION
Advanced age, DDLPS, PLS, stage III-IV disease, and poor tumor differentiation were identified as independent predictors of shorter PFS in RPLS patients following R0 resection.
目的
本研究旨在确定影响腹膜后脂肪肉瘤（RPLS）患者R0切除术后无进展生存期（PFS）的预后因素。
方法
对183例行R0切除的RPLS患者进行回顾性分析，评估其一般信息、临床病理数据、实验室参数及随访结果。根据随访结果，将患者分为无进展生存期（PFS）组（PFS，n = 121）和疾病进展组（DP，n = 62）。系统比较两组的一般信息、临床病理数据和实验室参数，将具有统计学意义的因素纳入Cox多因素回归分析。通过Cox分析确定的显著预后因素，进一步采用Kaplan-Meier（K-M）生存分析进行评估，为构建预测模型奠定基础。对该模型在1年、3年和总体PFS预测方面的性能进行严格评估。
结果
多因素分析确定年龄（= 1.034，95%CI = 1.011 - 1.057，= 0.003）、组织学亚型（以高分化脂肪肉瘤为参照。去分化脂肪肉瘤：= 0.130，95%CI = 0.029 - 0.578，= 0.007。黏液样/圆形细胞脂肪肉瘤：= 0.190，95%CI = 0.084 - 1.635，= 0.190。多形性脂肪肉瘤：= 0.176，95%CI = 0.036 - 0.865，= 0.032。混合型脂肪肉瘤：= 0.793，95%CI = 0.157 - 4.008，= 0.799）、肿瘤分期（= 0.440，95%CI = 0.257 - 0.755，= 0.003）和肿瘤分化程度（= 0.395，95%CI = 0.236 - 0.661，< 0.001）为独立危险因素。预测模型显示出良好的判别能力：1年模型（AUC = 0.944，NB = 0.05 - 0.80），3年模型（AUC = 0.861，NB = 0.05 - 0.73），总体模型（AUC = 0.903，NB = 0.03 - 0.90）。
结论
高龄、去分化脂肪肉瘤、多形性脂肪肉瘤、Ⅲ - Ⅳ期疾病以及肿瘤分化差被确定为RPLS患者R0切除术后PFS较短的独立预测因素。
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