M Toulmonde1, S Bonvalot2, P Méeus3, E Stoeckle4, O Riou5, N Isambert6, E Bompas7, M Jafari8, C Delcambre-Lair9, E Saada10, A Le Cesne11, C Le Péchoux12, J Y Blay13, S Piperno-Neumann14, C Chevreau15, J O Bay16, V Brouste17, P Terrier18, D Ranchère-Vince19, A Neuville20, A Italiano21. 1. Department of Medical Oncology, Institut Bergonié, Bordeaux. Electronic address: m.toulmonde@bordeaux.unicancer.fr. 2. Department of Surgical Oncology, Institut Gustave Roussy, Villejuif. 3. Department of Surgical Oncology, Centre Léon Bérard, Lyon. 4. Department of Surgical Oncology, Institut Bergonié, Bordeaux. 5. Department of Radiation Oncology, Institut Régional du Cancer Montpellier, Montpellier. 6. Department of Medical Oncology, Centre Georges François Leclerc, Dijon. 7. Department of Medical Oncology, Centre René Gauducheau, Nantes. 8. Department of Medical Oncology, Centre Oscar Lambret, Lille. 9. Department of Medical Oncology, Centre François Baclesse, Caen. 10. Department of Medical Oncology, Centre Antoine Lacassagne, Nice. 11. Departments of Medical Oncology. 12. Radiation Oncology, Institut Gustave Roussy, Villejuif. 13. Department of Medical Oncology, Centre Léon Bérard, Lyon. 14. Department of Medical Oncology, Institut Curie, Paris. 15. Department of Medical Oncology, Centre Claudius Regaud, Toulouse. 16. Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand. 17. Department of Clinical and Epidemiological Research, Institut Bergonié, Bordeaux. 18. Department of Pathology, Institut Gustave Roussy, Villejuif. 19. Department of Pathology, Centre Léon Bérard, Lyon. 20. Department of Pathology, Institut Bergonié, Bordeaux, France. 21. Department of Medical Oncology, Institut Bergonié, Bordeaux.
Abstract
BACKGROUND: Retroperitoneal sarcomas (RPS) are heterogeneous. No previous study has investigated the impact of specialized surgery, evaluated locoregional relapse (LRR), abdominal sarcomatosis and distant metastatic relapse as separate events, or considered histological subtypes separately. This study addresses these specific points in a homogeneous cohort of patients with completely resected primary RPS. PATIENTS AND METHODS: We conducted a retrospective analysis of adult patients diagnosed with a RPS between 1 January 1988 and 31 December 2008 and eventually referred to one of 12 centers of the French Sarcoma Group. All cases were centrally reviewed by an expert pathologist. RESULTS: Five hundred eighty-six patients were included. Median follow-up was 6.5 years [95% confidence interval (CI) 5.9-7.1]. Five hundred thirty-seven patients had localized disease and 389 patients (76%) had macroscopically complete resection of the tumor. In this latter group, the 5-year LRR-free survival rate was 46% [41-52] and the 5-year overall survival (OS) rate was 66% [61-71]. In multivariate analysis, gender, adjacent organ involvement, specialization of the surgeon, piecemeal resection and perioperative radiotherapy were independently associated with LRR. Specialization of the surgeon and piecemeal resection were independently associated with abdominal sarcomatosis whereas histology and adjacent organ involvement were independently associated with distant metastasis. Age, gender, grade, adjacent organ involvement and piecemeal resection were significantly associated with OS. Prognostic factors for LRR and OS were analyzed in well-differentiated and dedifferentiated liposarcomas and leiomyosarcomas. Grade 3 was an independent prognostic factor for OS of dedifferentiated liposarcomas. CONCLUSION: This study underlines the crucial role of pretherapeutic assessment and meticulous histological examination of RPS as well as the need to consider histological subtypes separately. Surgery in a specialized center and avoidance of piecemeal resection stand out as the two most important prognostic factors for RPS and highlight the importance of treating these patients in specialized centers.
BACKGROUND:Retroperitoneal sarcomas (RPS) are heterogeneous. No previous study has investigated the impact of specialized surgery, evaluated locoregional relapse (LRR), abdominal sarcomatosis and distant metastatic relapse as separate events, or considered histological subtypes separately. This study addresses these specific points in a homogeneous cohort of patients with completely resected primary RPS. PATIENTS AND METHODS: We conducted a retrospective analysis of adult patients diagnosed with a RPS between 1 January 1988 and 31 December 2008 and eventually referred to one of 12 centers of the French Sarcoma Group. All cases were centrally reviewed by an expert pathologist. RESULTS: Five hundred eighty-six patients were included. Median follow-up was 6.5 years [95% confidence interval (CI) 5.9-7.1]. Five hundred thirty-seven patients had localized disease and 389 patients (76%) had macroscopically complete resection of the tumor. In this latter group, the 5-year LRR-free survival rate was 46% [41-52] and the 5-year overall survival (OS) rate was 66% [61-71]. In multivariate analysis, gender, adjacent organ involvement, specialization of the surgeon, piecemeal resection and perioperative radiotherapy were independently associated with LRR. Specialization of the surgeon and piecemeal resection were independently associated with abdominal sarcomatosis whereas histology and adjacent organ involvement were independently associated with distant metastasis. Age, gender, grade, adjacent organ involvement and piecemeal resection were significantly associated with OS. Prognostic factors for LRR and OS were analyzed in well-differentiated and dedifferentiated liposarcomas and leiomyosarcomas. Grade 3 was an independent prognostic factor for OS of dedifferentiated liposarcomas. CONCLUSION: This study underlines the crucial role of pretherapeutic assessment and meticulous histological examination of RPS as well as the need to consider histological subtypes separately. Surgery in a specialized center and avoidance of piecemeal resection stand out as the two most important prognostic factors for RPS and highlight the importance of treating these patients in specialized centers.
Entities:
Keywords:
histology; prognosis; retroperitoneal sarcoma; surgery
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