Preoperative radiotherapy in the management of retroperitoneal liposarcoma
Preoperative radiotherapy in the management of retroperitoneal liposarcoma
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DOI：
10.1002/bjs.10305
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发表时间：
2016-12-01
影响因子：
9.6
通讯作者：
Karakousis, G. C.
中科院分区：
文献类型：
--
作者：
Ecker, B. L.;Peters, M. G.;Karakousis, G. C.
背景组织学亚型影响腹膜后肉瘤的预后和治疗失败模式。先前关于新辅助放疗（NRT）疗效的研究已将多种组织学类型与异质性肿瘤生物学结合起来。 NRT 对腹膜后脂肪肉瘤患者的生存影响尚不清楚。方法在美国国家癌症数据库（2004-2013 年）中确定了因腹膜后脂肪肉瘤而接受根治性切除术以及仅接受 NRT 或手术的患者。 Cox 回归用于识别与总体生存相关的协变量。 NRT 和单纯手术队列根据 Cox 模型的生存风险进行倾向评分 1:1 匹配。通过Kaplan-Meier估计比较总生存率。结果共鉴定出2082名腹膜后脂肪肉瘤患者； 1908 例仅接受手术，174 例在手术切除前接受 NRT。肿瘤中位大小为 220 厘米，349% 的肿瘤为高级别。在未匹配的队列中，NRT 与总生存期改善无关（(2)=349，P = 0062）。在倾向评分匹配队列中，NRT 与生存率改善相关（中位总生存期为 1292 个月与 843 个月；P = 0046；风险比 (HR) 154，95% c.i. 101 至 236）。对于邻近器官侵犯的肿瘤，这种效果最为明显（未达到中位总生存期 vs 638 个月；P = 0044；HR 179、101 至 319）。结论 NRT 改善了接受腹膜后脂肪肉瘤手术的患者的生存期，特别是具有高风险病理特征的患者。
BackgroundHistological subtype influences both prognosis and patterns of treatment failure in retroperitoneal sarcoma. Previous studies on the efficacy of neoadjuvant radiotherapy (NRT) have incorporated multiple histological types with heterogeneous tumour biology. The survival impact of NRT specifically for patients with retroperitoneal liposarcoma is poorly defined.MethodsPatients who underwent resection with curative intent for retroperitoneal liposarcoma and who received NRT or surgery alone were identified in the US National Cancer Data Base (2004-2013). Cox regression was used to identify co-variables associated with overall survival. NRT and surgery-alone cohorts were matched 1:1 by propensity scores based on the survival hazard on Cox modelling. Overall survival was compared by Kaplan-Meier estimates.ResultsA total of 2082 patients with retroperitoneal liposarcoma were identified; 1908 underwent surgery alone and 174 received NRT before surgical resection. Median tumour size was 220cm and 349 per cent of tumours were high grade. In the unmatched cohort, NRT was not associated with improved overall survival ((2)=349, P = 0062). In the propensity score-matched cohort, NRT was associated with an improvement in survival (median overall survival 1292 versus 843months; P = 0046; hazard ratio (HR) 154, 95 per cent c.i. 101 to 236). This effect appeared most pronounced for tumours with adjacent organ invasion (median overall survival not reached versus 638months; P = 0044; HR 179, 101 to 319).ConclusionNRT improved survival in patients undergoing surgery for retroperitoneal liposarcoma, particularly those with high-risk pathological features.