Retroperitoneal and Truncal Sarcomas: Prognosis Depends Upon Type Not Location

Ann Surg Oncol. 2007 Mar;14(3):1114-22. doi: 10.1245/s10434-006-9255-x. Epub 2007 Jan 7.

Abstract

Background: Prognostication of truncal and retroperitoneal soft tissue sarcomas has traditionally been predicated on tumor location and grade.

Objective: To compare outcomes for patients with retroperitoneal or truncal sarcomas.

Methods: Retrospective analysis of a prospective cancer data registry from 1977 to 2004 was performed and outcomes were determined.

Results: The study group numbered 312 patients (median age 58 years, 54% male, 56% Caucasian, 14% black, 29% Hispanic). The most common tumor types were liposarcoma (35.9%), leiomyosarcoma (30.1%), and malignant fibrous histiocytoma (MFH) (19.5%). Tumor distributions were retroperitoneal (38.9%), pelvic (24.7%), abdominal (18.6%) and thoracic (17.9%). Median overall survival was 74 months. Operative resection was undertaken in 89.4% of cases and multiple surgeries (range 2-5) in 42.2%. Negative resection margins were obtained in 72.7% of patients. Univariate analysis comparing retroperitoneal versus truncal location demonstrated no significant differences in survival. Survival was improved in lower grade tumors (P < 0.02). Liposarcoma and fibrosarcoma were associated with improved survival (P < 0.0001). Multivariate analysis of pre-treatment variables showed increasing age, grade, histopathology (leiomyosarcoma and MFH) and metastasis to be associated with worse outcomes. Multivariate analysis of the treatment variables showed that surgery and negative resection margins were associated with improved survival (P < 0.001). No advantage for chemoradiotherapy could be demonstrated.

Conclusions: Successful operative resection can confer prolonged disease-free survival and cure for truncal and retroperitoneal sarcomas. Histological subtype, not location, is predictive of long-term survival. Future studies should focus on histological subtype rather than tumor location for truncal and retroperitoneal sarcomas.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Extremities / pathology
  • Female
  • Fibrosarcoma / drug therapy
  • Fibrosarcoma / pathology
  • Fibrosarcoma / surgery
  • Histiocytoma, Benign Fibrous / drug therapy
  • Histiocytoma, Benign Fibrous / pathology
  • Histiocytoma, Benign Fibrous / surgery
  • Humans
  • Leiomyosarcoma / drug therapy
  • Leiomyosarcoma / pathology
  • Leiomyosarcoma / surgery
  • Liposarcoma / drug therapy
  • Liposarcoma / pathology
  • Liposarcoma / surgery
  • Male
  • Middle Aged
  • Prognosis
  • Retroperitoneal Neoplasms / drug therapy
  • Retroperitoneal Neoplasms / pathology*
  • Retroperitoneal Neoplasms / surgery
  • Retrospective Studies
  • Risk Factors
  • Sarcoma / drug therapy
  • Sarcoma / pathology*
  • Sarcoma / surgery
  • Soft Tissue Neoplasms / drug therapy
  • Soft Tissue Neoplasms / pathology*
  • Soft Tissue Neoplasms / surgery
  • Survival Rate
  • Time Factors