Abstract

Introduction: Retroperitoneal sarcomas (RPS) lie in the retroperitoneal space and are covered by a peritoneal layer. However, some RPS have an intraperitoneal component (IPC), which invades into the peritoneal cavity. The significance of such a clinical presentation is unknown. Methods: We retrospectively analyzed our prospectively maintained institutional database of RPS, along with intraoperative photographs taken to document the primary tumor extent at laparotomy. The effects of IPC on overall survival (OS), local recurrence (LR), and distant metastasis (DM) were evaluated. Results: IPC was present in 81 of 493 patients (16.4%). It was significantly associated with older age (64 vs. 59, p = 0.008), gender (67% vs. 33% males, p = 0.005), and multifocality (11.1% vs. 0.5%; p < 0.0001). IPC was not associated with size or any specific histology, while it showed a weak association with high malignancy grade (40.7% vs. 28.6% in G3 tumors; p = 0.076). At a median follow-up of 32 months IPC was associated with worse 5-year OS (54% vs. 74%, p < 0.001) and crude cumulative incidence (CCI) of LR (5-year CCI of LR: 38% vs. 19%, p = 0.001), but not to CCI of DM. However, multivariable models showed that IPC’s effect on OS (HR: 1.52, 95% CI 0.92–2.49, p = 0.1) and LR (HR: 1.34, 95% CI 0.8–2.26, p = 0.27) could be sufficiently explained by other known risk factors. Conclusions: IPC is associated with increased LR and decreased survival. However, the effect of IPC on prognosis is predominantly related to other tumor characteristics already included in published nomograms. IPC should not be a contraindication to a proper surgical resection.

Original languageEnglish
Pages (from-to)3535-3541
Number of pages7
JournalAnnals of Surgical Oncology
Volume26
Issue number11
DOIs
Publication statusPublished - Oct 1 2019

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Sarcoma
Recurrence
Survival
Neoplasms
Incidence
Retroperitoneal Space
Neoplasm Metastasis
Nomograms
Peritoneal Cavity
Laparotomy
Histology
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{1fc5c66006c24a0fb8a3980e306f1eb8,
title = "Intraperitoneal Invasion of Retroperitoneal Sarcomas: A Risk Factor for Dismal Prognosis",
abstract = "Introduction: Retroperitoneal sarcomas (RPS) lie in the retroperitoneal space and are covered by a peritoneal layer. However, some RPS have an intraperitoneal component (IPC), which invades into the peritoneal cavity. The significance of such a clinical presentation is unknown. Methods: We retrospectively analyzed our prospectively maintained institutional database of RPS, along with intraoperative photographs taken to document the primary tumor extent at laparotomy. The effects of IPC on overall survival (OS), local recurrence (LR), and distant metastasis (DM) were evaluated. Results: IPC was present in 81 of 493 patients (16.4{\%}). It was significantly associated with older age (64 vs. 59, p = 0.008), gender (67{\%} vs. 33{\%} males, p = 0.005), and multifocality (11.1{\%} vs. 0.5{\%}; p < 0.0001). IPC was not associated with size or any specific histology, while it showed a weak association with high malignancy grade (40.7{\%} vs. 28.6{\%} in G3 tumors; p = 0.076). At a median follow-up of 32 months IPC was associated with worse 5-year OS (54{\%} vs. 74{\%}, p < 0.001) and crude cumulative incidence (CCI) of LR (5-year CCI of LR: 38{\%} vs. 19{\%}, p = 0.001), but not to CCI of DM. However, multivariable models showed that IPC’s effect on OS (HR: 1.52, 95{\%} CI 0.92–2.49, p = 0.1) and LR (HR: 1.34, 95{\%} CI 0.8–2.26, p = 0.27) could be sufficiently explained by other known risk factors. Conclusions: IPC is associated with increased LR and decreased survival. However, the effect of IPC on prognosis is predominantly related to other tumor characteristics already included in published nomograms. IPC should not be a contraindication to a proper surgical resection.",
author = "Eran Nizri and Marco Fiore and Francesco Barretta and Chiara Colombo and Stefano Radaelli and Dario Callegaro and Roberta Sanfilippo and Claudia Sangalli and Paola Collini and Silvia Stacchiotti and Casali, {Paolo G.} and Rosalba Miceli and Alessandro Gronchi",
year = "2019",
month = "10",
day = "1",
doi = "10.1245/s10434-019-07615-1",
language = "English",
volume = "26",
pages = "3535--3541",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York LLC",
number = "11",

}

TY - JOUR

T1 - Intraperitoneal Invasion of Retroperitoneal Sarcomas

T2 - A Risk Factor for Dismal Prognosis

AU - Nizri, Eran

AU - Fiore, Marco

AU - Barretta, Francesco

AU - Colombo, Chiara

AU - Radaelli, Stefano

AU - Callegaro, Dario

AU - Sanfilippo, Roberta

AU - Sangalli, Claudia

AU - Collini, Paola

AU - Stacchiotti, Silvia

AU - Casali, Paolo G.

AU - Miceli, Rosalba

AU - Gronchi, Alessandro

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Introduction: Retroperitoneal sarcomas (RPS) lie in the retroperitoneal space and are covered by a peritoneal layer. However, some RPS have an intraperitoneal component (IPC), which invades into the peritoneal cavity. The significance of such a clinical presentation is unknown. Methods: We retrospectively analyzed our prospectively maintained institutional database of RPS, along with intraoperative photographs taken to document the primary tumor extent at laparotomy. The effects of IPC on overall survival (OS), local recurrence (LR), and distant metastasis (DM) were evaluated. Results: IPC was present in 81 of 493 patients (16.4%). It was significantly associated with older age (64 vs. 59, p = 0.008), gender (67% vs. 33% males, p = 0.005), and multifocality (11.1% vs. 0.5%; p < 0.0001). IPC was not associated with size or any specific histology, while it showed a weak association with high malignancy grade (40.7% vs. 28.6% in G3 tumors; p = 0.076). At a median follow-up of 32 months IPC was associated with worse 5-year OS (54% vs. 74%, p < 0.001) and crude cumulative incidence (CCI) of LR (5-year CCI of LR: 38% vs. 19%, p = 0.001), but not to CCI of DM. However, multivariable models showed that IPC’s effect on OS (HR: 1.52, 95% CI 0.92–2.49, p = 0.1) and LR (HR: 1.34, 95% CI 0.8–2.26, p = 0.27) could be sufficiently explained by other known risk factors. Conclusions: IPC is associated with increased LR and decreased survival. However, the effect of IPC on prognosis is predominantly related to other tumor characteristics already included in published nomograms. IPC should not be a contraindication to a proper surgical resection.

AB - Introduction: Retroperitoneal sarcomas (RPS) lie in the retroperitoneal space and are covered by a peritoneal layer. However, some RPS have an intraperitoneal component (IPC), which invades into the peritoneal cavity. The significance of such a clinical presentation is unknown. Methods: We retrospectively analyzed our prospectively maintained institutional database of RPS, along with intraoperative photographs taken to document the primary tumor extent at laparotomy. The effects of IPC on overall survival (OS), local recurrence (LR), and distant metastasis (DM) were evaluated. Results: IPC was present in 81 of 493 patients (16.4%). It was significantly associated with older age (64 vs. 59, p = 0.008), gender (67% vs. 33% males, p = 0.005), and multifocality (11.1% vs. 0.5%; p < 0.0001). IPC was not associated with size or any specific histology, while it showed a weak association with high malignancy grade (40.7% vs. 28.6% in G3 tumors; p = 0.076). At a median follow-up of 32 months IPC was associated with worse 5-year OS (54% vs. 74%, p < 0.001) and crude cumulative incidence (CCI) of LR (5-year CCI of LR: 38% vs. 19%, p = 0.001), but not to CCI of DM. However, multivariable models showed that IPC’s effect on OS (HR: 1.52, 95% CI 0.92–2.49, p = 0.1) and LR (HR: 1.34, 95% CI 0.8–2.26, p = 0.27) could be sufficiently explained by other known risk factors. Conclusions: IPC is associated with increased LR and decreased survival. However, the effect of IPC on prognosis is predominantly related to other tumor characteristics already included in published nomograms. IPC should not be a contraindication to a proper surgical resection.

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U2 - 10.1245/s10434-019-07615-1

DO - 10.1245/s10434-019-07615-1

M3 - Article

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VL - 26

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EP - 3541

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 11

ER -