Multifocality in Retroperitoneal Sarcoma A Prognostic Factor Critical to Surgical Decision-Making
Multifocality in Retroperitoneal Sarcoma A Prognostic Factor Critical to Surgical Decision-Making
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DOI：
10.1097/sla.0b013e3181928f2f
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发表时间：
2009-01-01
影响因子：
9
通讯作者：
Pollock, Raphael E.
中科院分区：
文献类型：
--
作者：
Anaja, Daniel A.;Lahat, Guy;Pollock, Raphael E.
目的：评估腹膜后肉瘤（RPS）患者多灶性对总生存期（CS）的意义，并建立一个数据来源的、对预后和治疗有用的肉瘤定义。背景资料：RPS多灶性的发病率、临床特征和预后意义尚不清楚。目前尚无肉瘤病的标准化定义。方法：我们对1996年至2006年间在一家综合癌症中心接受原发性或复发性非转移性RPS治疗的393例患者进行了回顾性分析。比较单灶性和多灶性疾病患者的基线和治疗变量。采用多变量模型评估多灶性与OS的关系，并确定多灶性疾病患者的其他预后因素。结果：所有患者的中位随访时间为69个月；79例（20%）患者表现为多灶性疾病。多灶组的5年OS率低于单灶组（分别为31%和60%，P < 0.0001）。多因素分析后，多焦点仍然是较差CS的独立预测因子{风险比（HR） 1.7(95%可信区间（CI）， 1.2-2.5)；P = 0.0041}。此外，肿瘤较多的患者预后明显较差(bbb70肿瘤，HR 2.1 (95% CI, 1.1-3.9)；P = 0.03)， 5年OS率为70%。结论：原发性或复发性RPS患者的多灶性RPS与较差的OS相关；bbb70肿瘤患者预后最差。该标准可用于定义肉瘤病，从而确定患者的生存最终取决于有效的全身治疗。
Objective: To evaluate the significance of multifocality on overall survival (CS) in patients with retroperitoneal sarcoma (RPS) and establish a data-derived, prognostically and therapeutically useful definition of sarcomatosis.Summary Background Data: The incidence, clinical features, and prognostic significance of multifocality in RPS is unknown. No current standardized definition for sarcomatosis is available.Methods: We conducted a retrospective analysis of 393 patients with primary or recurrent nonmetastatic RPS treated at a comprehensive cancer center between 1996 and 2006. Baseline and treatment variables were compared in patients with unifocal and multifocal disease. A multivariate model was used to evaluate the association of multifocality and OS and identify additional prognostic factors in patients with multifocal disease.Results: The median follow-up time for all patients was 69 months; 79 patients (20%) presented with multifocal disease. The 5-year OS rate was less in the multifocal group compared with the unifocal group (31% vs. 60%, respectively; P < 0.0001). After multivariate analysis, multifocality remained an independent predictor of worse CS {hazard ratio (HR) 1.7 (95% confidence interval (CI), 1.2-2.5); P = 0.0041}. Additionally, patients with more tumors had significantly worse prognosis (>7 tumors, HR 2.1 (95% CI, 1.1-3.9); P = 0.03), with a 5-year OS rate of 70%.Conclusions: Multifocal RPS is associated with worse OS in patients with either primary or recurrent RPS; Patients with >7 tumors had the worst prognosis. This criterion can be used to define sarcomatosis, thereby idenfifying patients whose survival will ultimately depend on effective systemic therapy.