Radical Versus Non-Radical Resection for Early-Stage Retroperitoneal Sarcoma: A Propensity Score-Matched Analysis.

Chengxin Weng,Jiarong Wang,Bin Huang,Ding Yuan,Jichun Zhao,Tiehao Wang

doi:10.3389/fonc.2021.706543

Chengxin Weng, Jiarong Wang + Show 4 more

Open Access

https://doi.org/10.3389/fonc.2021.706543

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Abstract

BackgroundThe appropriate surgical procedure for early-stage retroperitoneal sarcoma (RPS) is unclear. Thus, we used a national database to compare the outcomes of radical and non-radical resection in patients with early stage RPS.MethodsThis retrospective study included 886 stage I RPS patients from 2004 to 2015 in the SEER database. Outcomes were compared using the multivariate Cox proportional hazards models and the results were presented as adjusted hazards ratio (AHR) with corresponding 95% confidence intervals (95%CIs). Propensity score-matched analyses were also performed for sensitive analyses.ResultsFor the 886 stage I RPS patients, 316 underwent radical resection, and 570 underwent non-radical resection, with a median follow-up of 4.58 (2.73-8.35) years. No difference was observed in overall mortality (AHR 0.84, 95%CI 0.62-1.15; P = 0.28) or RPS-specific mortality (AHR 0.88, 95%CI 0.57-1.36; P = 0.56) between groups. The results were similar in propensity score-matching analyses. However, subgroup analysis revealed that radical resection was associated with significantly decreased risks of overall mortality in male (AHR 0.61, 95%CI 0.38-0.98; P = 0.04) and in patients with radiotherapy (AHR 0.56, 95%CI 0.32-0.98; P = 0.04).ConclusionRadical resection did not improve midterm survival outcomes compared with non-radical resection in overall patients with early stage RPS. However, male patients or patients who received radiotherapy might benefit from radical resection with improved overall survival.

Highlights

Retroperitoneal sarcomas (RPSs) are rare types of sarcomas arising from the retroperitoneum, which represent approximately 15% of all soft tissue sarcomas [1]
The patients diagnosed with stage IA [59(7.1%)] retroperitoneal sarcomas were rare in this study
Our study showed that using radical resections and radiotherapy in early-stage RPS patients was relatively safe

Summary

Introduction

Retroperitoneal sarcomas (RPSs) are rare types of sarcomas arising from the retroperitoneum, which represent approximately 15% of all soft tissue sarcomas [1]. The long-term prognosis of RPSs varies the between subtypes but is always relatively poor, with a 5-year overall survival of approximately 50% [5]. Many centers proposed a radical surgical strategy involving en bloc resections of the tumors with adjacent organs or structures to achieve maximum R0 resection and minimize the risk of local recurrence [8, 9]. Surrounding structures (e.g. psoas, kidney, or part of the colon), were excised with the mass even when not infiltrated. These radical resections may increase the risk of major postoperative morbidity and affect the quality of life in high-risk patients [10].

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