title: Personalizing the approach to retroperitoneal soft tissue sarcoma: histology-specific patterns of failure and postrelapse outcome after primary extended resection.
abstract: OBJECTIVE
  To explore patterns of failure and postrelapse outcome of patients with retroperitoneal sarcoma primarily treated by extended resection.
  
  
  METHODS
  All consecutive patients with primary retroperitoneal sarcoma, treated between January 2002 and December 2011 at two European sarcoma centers were included. Five-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastases (DM) were calculated. Multivariate analyses for OS and CCI of LR and DM were performed. Postrelapse OS was investigated.
  
  
  RESULTS
  A total of 377 patients were identified. Median follow-up from the time of primary surgery was 44 months [interquartile range (IQR) 27-82]. Five-year OS was 64 % [95 % confidence interval (CI) 0.588, 0710]. CCI of LR and DM were 23.6 % (95 % CI 18.9, 29.4) and 21.9 % (95 % CI 17.6, 27.3), respectively. OS, CCI of LR and DM were 87, 18 % and 0 for well-differentiated liposarcoma; 54, 44 and 9 % for grade II dedifferentiated liposarcoma; 41,33, and 44 % for grade III dedifferentiated liposarcoma; 58, 5, and 55 % for leiomyosarcoma; and 85, 4, and 17 % for solitary fibrous tumor, respectively. Seventy-six patients developed LR. Median postrelapse follow-up was 27 months (IQR 10-58). Twenty-one patients (27 %) underwent a second surgical resection (complete in 18), while 55 (73 %) did not (22 multifocal, 17 inoperable, 16 other causes). Median postrelapse OS was 17 months (IQR 7-31). Well-differentiated liposarcoma histology and disease-free interval predicted postrelapse OS, while surgical resection did not.
  
  
  CONCLUSIONS
  When primary extended surgery limits LR, histologic subtype and grade determine the outcome. At recurrence, a second surgery is of limited benefit.
authors.affiliation: Department of Surgery, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy, alessandro.gronchi@istitutotumori.mi.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gronchi
authors.forename: Rosalba
authors.initials: R
authors.lastname: Miceli
authors.forename: Marc Antoine
authors.initials: MA
authors.lastname: Allard
authors.forename: Dario
authors.initials: D
authors.lastname: Callegaro
authors.forename: Cecile
authors.initials: C
authors.lastname: Le Péchoux
authors.forename: Marco
authors.initials: M
authors.lastname: Fiore
authors.forename: Charles
authors.initials: C
authors.lastname: Honoré
authors.forename: Roberta
authors.initials: R
authors.lastname: Sanfilippo
authors.forename: Sara
authors.initials: S
authors.lastname: Coppola
authors.forename: Silvia
authors.initials: S
authors.lastname: Stacchiotti
authors.forename: Philippe
authors.initials: P
authors.lastname: Terrier
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Casali
authors.forename: Axel
authors.initials: A
authors.lastname: Le Cesne
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Chiara
authors.initials: C
authors.lastname: Colombo
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonvalot
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006652:Histological Techniques; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications; D057285:Precision Medicine; D011379:Prognosis; D011446:Prospective Studies; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D012509:Sarcoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate