title: Long-term outcomes in treatment of retroperitoneal sarcomas: A 15 year single-institution evaluation of prognostic features.
abstract: BACKGROUND
  Retroperitoneal sarcomas are connective tissue tumors arising in the retroperitoneum. Surgical resection is the mainstay of treatment. Debate has arisen over extent of resection, changes in histological classification/grading, and interest in incorporating radiotherapy. Therefore, we reviewed our institution's experience to evaluate prognostic factors.
  
  
  METHODS
  Retrospective chart review of all primary RPS patients at Johns Hopkins Hospital from 1994 to 2010. Histologic diagnosis and grading were re-evaluated with current criteria. Prognostic factors for survival, and recurrence were assessed.
  
  
  RESULTS
  One hundred thirty-one primary RPS patients met inclusion criteria. Median survival for patients who undergo en-bloc resection to negative margins (R0/R1) is 81.7 months. Surgical margins and grade were the most important factors for survival along with age, gender, presence of metastases and resection of ≥5 organs. Five-year survival for R0/R1 resection was 60%, similar to compartmental resection. Radiotherapy significantly decreased local recurrence (P = 0.026) on multivariate analysis. Grade in leiomyosarcomas and dedifferentiation in liposarcomas dictated patterns of local versus distal recurrence.
  
  
  CONCLUSIONS
  En bloc surgical resection to R0/R1 margins remains the cornerstone of therapy and provides comparable outcomes to compartmental resections. Grade remains important for prognosis, and histology dictates recurrence patterns. Radiotherapy appears promising for local control and warrants further investigation. J. Surg. Oncol. 2016;114:56-64. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Eihab
authors.initials: E
authors.lastname: Abdelfatah
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Angela A
authors.initials: AA
authors.lastname: Guzzetta
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Neeraja
authors.initials: N
authors.lastname: Nagarajan
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Richard
authors.initials: R
authors.lastname: Schulick
authors.affiliation: Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Montgomery
authors.affiliation: Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Katherine
authors.initials: K
authors.lastname: Thornton
authors.affiliation: Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Herman
authors.affiliation: Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Terezakis
authors.affiliation: Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Deborah
authors.initials: D
authors.lastname: Frassica
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents
keywords: compartmental resection; grade; leiomyosarcoma; liposarcoma; radiation; sarcoma