Abstract
Simple SummaryRetroperitoneal sarcomas are difficult malignancies to treat because complete surgical resection is the only effective treatment option, but it is difficult to secure sufficient surgical margins. It is essential for developing a treatment strategy to assess tumor aggressiveness and predict prognosis for patients. However, the aggressiveness of retroperitoneal sarcomas before treatment cannot be fully evaluated. In patients with resectable soft tissue sarcomas or several carcinomas, SUV evaluated with FDG-PET has been reported to be a valuable prognostic parameter. However, the correlation between SUVmax on FDG-PET and the prognosis of several histological subtypes in retroperitoneal sarcoma, including dedifferentiated liposarcoma, well-differentiated liposarcoma, and leiomyosarcoma, remains uncertain. This study revealed that SUVmax calculated with FDG-PET was useful as a prognostic factor in retroperitoneal sarcoma, especially in dedifferentiated liposarcoma and Grade2 retroperitoneal sarcoma.Background: Retroperitoneal sarcomas are rare neoplasms that occur in the retroperitoneum. Complete surgical resection is the only effective treatment option. The prediction of prognosis by histological diagnosis has not yet been established. The purpose of this study was to identify the usefulness of [18-F] fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging for validating the prognosis of retroperitoneal sarcoma (RPS) established by histological diagnosis. Methods: We retrospectively reviewed 201 patients with RPS treated at the Osaka International Cancer Institute between 2010 and 2021. We extracted the clinical data, including standardized uptake values (SUVs), evaluated with FDG-PET, and statistically analyzed the data. Results: The median age of patients was 64 years (range, 31–85 years). A total of 101 (50.2%) patients were men, and 100 (49.8%) were women. Surgical resection was performed in 155 (77.1%) patients. On histological analysis, 75 (37.3%), 52 (25.9%), and 29 (14.4%) patients were diagnosed with dedifferentiated liposarcoma, well-differentiated liposarcoma, and leiomyosarcoma, respectively. The median survival time for patients with high maximum SUV (SUVmax) (≥4) or low SUVmax (<4) was 275.8 months and 79.5 months, respectively. Furthermore, among the patients with dedifferentiated liposarcoma, the overall survival rate for patients with high SUVmax (≥4) was significantly lower than that of those with low SUVmax (<4). Conclusions: The present study demonstrated that SUVmax calculated with FDG-PET was useful as a prognostic factor in RPS, especially in dedifferentiated liposarcoma and Grade2 RPS. To devise a treatment strategy for RPS, SUVmax during FDG-PET scan may be considered for clinical assessment.
Highlights
Retroperitoneal sarcoma (RPS) is a rare mesenchymal tumor consisting of approximately 10% of all soft tissue sarcomas (STS) [1,2,3]
We investigated the involvement of SUVmax in the clinical outcome of retroperitoneal sarcoma (RPS) patients compared with other candidate prognostic factors
Sambri bri et al demonstrated that sarcoma patients with SUVmax of less than 10.3 showed a et al demonstrated that sarcoma patients with SUVmax of less than 10.3 showed a better prognosis and low recurrence rate in some histological types [16]
Summary
Retroperitoneal sarcoma (RPS) is a rare mesenchymal tumor consisting of approximately 10% of all soft tissue sarcomas (STS) [1,2,3]. Complete resection by surgery is the only effective treatment to improve prognosis, it is difficult to secure sufficient surgical margins because of the tumor size and location of the RPS [6,7]. Unlike soft tissue sarcoma of the extremities, multimodality treatment of surgical resection combined with chemotherapy and/or radiotherapy for RPS has not been established. The most beneficial treatment strategy for RPS might be repeated excision for primary and recurrent or metastatic tumors, and chemotherapy and/or radiotherapy are considered effective when the tumors become unresectable [6]. Imaging for validating the prognosis of retroperitoneal sarcoma (RPS) established by histological diagnosis. A total of 101 (50.2%) patients were men, and
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