Post-relapse outcomes after primary extended resection of retroperitoneal sarcoma: A report from the Trans-Atlantic RPS Working Group.
Despite a radical surgical approach to primary retroperitoneal sarcoma (RPS), many patients experience locoregional and/or distant recurrence. The objective of this study was to analyze post-relapse outcomes for patients with RPS who had initially undergone surgical resection of their primary tumor at a specialist center.



All consecutive patients who underwent macroscopically complete resection for primary RPS at 8 high volume centers from January 2002 to December 2011 were identified, and those who developed local recurrence (LR) only, distant metastasis (DM) only, or synchronous local recurrence and distant metastasis (LR+DM) during the follow-up period were included. Overall survival (OS) was calculated for all groups, as was the crude cumulative incidence of a second recurrence after the first LR. Multivariate analyses for OS were performed.



In an initial series of 1007 patients with primary RPS, 408 patients developed recurrent disease during the follow-up period. The median follow-up from the time of recurrence was 41 months. The median OS was 33 months after LR (n = 219), 25 months after DM (n = 146), and 12 months after LR+DM (n = 43), and the 5-year OS rates were 29%, 20%, and 14%, respectively. Predictors of OS after LR were the time interval to LR and resection of LR, while histologic grade approached significance. For DM, significant predictors of OS were the time interval to DM and histologic subtype. The subgroup of patients who underwent resection of recurrent disease had a longer median OS than patients who did not undergo resection.



Relapse of RPS portends high disease-specific mortality. Patients with locally recurrent or metastatic disease should be considered for resection. Cancer 2017;123:1971-1978. © 2017 American Cancer Society.
Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.|Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy.
Andrea J
AJ
MacNeill
Department of Biostatistics, IRCCS Foundation National Cancer Institute, Milan, Italy.
Rosalba
R
Miceli
Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom.
Dirk C
DC
Strauss
Department of Surgery, Curie Institute, Paris, France.
Sylvie
S
Bonvalot
University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
Peter
P
Hohenberger
Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Frits
F
Van Coevorden
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Piotr
P
Rutkowski
Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy.
Dario
D
Callegaro
Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom.
Andrew J
AJ
Hayes
Department of Surgery, Gustave Roussy Institute, Villejuif, France.
Charles
C
Honoré
Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital and Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
Mark
M
Fairweather
Ontario Institute for Cancer Research, MaRS Centre, Toronto, Ontario, Canada.
Amanda
A
Cannell
University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
Jens
J
Jakob
Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Rick L
RL
Haas
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Milena
M
Szacht
Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy.
Marco
M
Fiore
Department of Cancer Medicine, IRCCS Foundation National Cancer Institute, Milan, Italy.
Paolo G
PG
Casali
Division of Surgical Oncology, Department of Surgery, Ohio State University Medical Center, Columbus, Ohio.
Raphael E
RE
Pollock
Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital and Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
Chandrajit P
0000-0001-7297-3221
CP
Raut
Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy.
Alessandro
A
Gronchi
Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Carol J
CJ
Swallow
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008080:Liposarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D011878:Radiotherapy; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D054364:Solitary Fibrous Tumors / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
D000970:Antineoplastic Agents
distant metastases; local recurrence; prognostic factors; retroperitoneal sarcoma; sarcoma; surgery; survival