Incidence and Adverse Prognostic Implications of Histopathologic Organ Invasion in Primary Retroperitoneal Sarcoma

• Published in: Journal of the American College of Surgeons Vol. 224; no. 5; pp. 876 - 883
• Main Authors: Fairweather, Mark, MD, Wang, Jiping, MD, PhD, FACS, Jo, Vickie Y., MD, Baldini, Elizabeth H., MD, MPH, Bertagnolli, Monica M., MD, FACS, Raut, Chandrajit P., MD, MSc, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Adult; Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - epidemiology; Prognosis; Retroperitoneal Neoplasms - epidemiology; Retroperitoneal Neoplasms - pathology; Retrospective Studies; Sarcoma - epidemiology; Sarcoma - pathology; Surgery; Survival Rate; retroperitoneal sarcoma; organ resection; organ invasion; surgery; DDLPS; HOI; LMS; OS; RPS; WDLPS; DM; LRR
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2017.01.044

Abstract Background The incidence of histopathologic organ invasion (HOI) in retroperitoneal sarcoma (RPS) is not well described. We reviewed our experience to investigate the rate and prognostic implications of HOI. Study Design Patients with primary RPS who underwent surgery at our institution were reviewed. HOI was defined as microscopic organ invasion confirmed by re-review of pathology slides by an expert sarcoma pathologist. Impact of HOI on the crude cumulative incidence (CCI) of locoregional recurrence (LRR), distant recurrence (DR) and overall survival (OS) rates was analyzed. Results Between 2002 and 2011, 118 patients underwent resection for primary RPS; 99 had at least one organ resected and among those, HOI was present in 58% (57/99). Among the 77 patients with the 3 most common histologies, rates of HOI were 61% for dedifferentiated liposarcoma, 56% for leiomyosarcoma, and 40% for well-differentiated liposarcoma. In this subset, HOI was associated with no difference in 2-year CCI of LRR (48% v. 47%, P =0.55) or DR (46% v. 22%, P =0.2). With a median follow-up of 33.6 months, HOI was an independent predictor of worse 5-year OS (34% v. 62%, P =0.04; hazard ratio 2.3, 95% confidence interval 1.2-4.4, P =0.02). Conclusions The likelihood of organ invasion may be predicted by histologic subtype of primary RPS. To the best of our knowledge, this is first study to demonstrate that HOI is associated with worse OS. These data may help guide the minimal extent of surgical resection required for RPS.