原发性腹膜后脂肪肉瘤复发和预后的影响因素

目的:探讨原发性腹膜后脂肪肉瘤复发和预后的影响因素。方法:回顾性分析2011年6月至2020年1月郑州大学第一附属医院接受手术治疗的89例原发性腹膜后脂肪肉瘤患者的临床资料，男42例，女47例。中位年龄53(26~78)岁。我院首次手术治疗65例，外院术后复发再次手术治疗24例。初诊临床表现：体检发现腹膜后肿物41例，...

Analysis of recurrent and prognosis factors of primary retroperitoneal liposarcoma

Objective To investigate the factors related to recurrence and prognosis of retroperitoneal liposarcoma.Method The clinical data of patients with primary retroperitoneal liposarcoma who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2011 to January 2020 were analyzed retrospectively.There were 42 males and 47 females and patients’median age was 53(26-78).Sixty-five cases were treated by operation in our hospital,and 24 cases were primarily treated by the operation in another hospital.The clinical manifestations of the initial diagnosis included retroperitoneal mass in 41 cases,abdominal distension in 12 cases,abdominal pain in 10 cases,fever in 11 cases,nausea,vomiting and poor appetite in 8 cases,frequent urination and dysuria in 6 cases,and bilateral lower limb edema in 1 case.Preoperative CT imaging showed that the tumor body was located in the retroperitoneal kidney area in 58 cases,while in the retroperitoneal space or the pelvic extraperitoneal space in 31 cases.There were 55 single cases and 34 multiple cases.The median tumor length was 20(3-52)cm.Among the primarily treated 65 patients,47(72.3%)were considered as primary retroperitoneal liposarcoma by preoperative imaging examination.Among the 89 patients treated by surgery,78 underwent endoscopic surgery,among which 21 underwent laparoscopic surgery,38 cases of retroperitoneal laparoscopic surgery,19 cases of Da Vinci robot-assisted laparoscopic surgery.Open operation was performed in 11 cases.There were 87 patients undergoing radical resection and 2 patients undergoing palliative resection.Forty-two patients underwent intraoperative combined resection of the adjacent organs.The recurrence and survival status of patients were followed up.Results All the 89 patients underwent the operation successfully,with the median operative blood loss of 200(10-2000)ml.There were 23 cases being diagnosed of well differentiated liposarcoma,40 cases of dedifferentiated,20 cases of myxoid/round,5 cases of myxoid liposarcoma,and 1 cases of mixed type.Pathologically,there 42 cases with low grade histology and 47 cases with high grade histology.In this study,89 patients were followed up for 3 to 108 months,and the median follow-up time was 28 months.The 5-year recurrence free survival rate,disease-free survival rate and overall survival rate of the patients were 16.7%,16.1%and 52.6%,respectively.There were 57 patients presenting local recurrence,1 patient of lung metastasis,and 1 patient of liver metastasis,and the median disease-free survival time was 24 months.There were 42 patients died of the disease,with a median survival time of 64 months.Univariate analysis showed that intraoperative blood loss(P<0.01),whether multiple cases(P<0.01),pathologic types(P<0.01),and histological grades(P<0.01)were related to disease-free survival.The intraoperative blood loss(P<0.01),multiple cases(P<0.05),pathologic types(P<0.05),and recurrence(P<0.01)were related with overall survival.Gender,age,tumor size,tumor location,whether primary surgery,radical resection or combined resection of adjacent organ had no effect on the prognosis of patients(P>0.05).Cox regression model multivariate analysis revealed that surgical bleeding(RR=2.360,95%CI 1.313-4.241,P=0.004),multiple tumor(RR=1.899,95%CI 1.068-3.375,P=0.029),and pathological type(RR=4.976,95%CI 1.622-15.264,P=0.005)were independent factors affecting disease-free survival.The recurrence was an independent factor affecting the overall survival of patients(RR=31.495,95%CI 1.062-933.684,P=0.046).Conclusions Retroperitoneal liposarcoma is a rare disease with high recurrence rate.The intraoperative blood loss,whether multiplicity and pathological type are independent factors affecting the disease-free survival,and recurrence is independent factors affecting the overall survival.