Local Recurrence Growth Rate Predicts Outcome
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Local Recurrence Growth Rate Predicts Outcome In Locally Recurrent Retroperitoneal Liposarcoma PowerPoint PPT Presentation


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Local Recurrence Growth Rate Predicts Outcome In Locally Recurrent Retroperitoneal Liposarcoma. James Park, MD, Li-Xuan Qin, PhD, Francesco Prete, MD Murray Brennan, MD, Samuel Singer, MD. Background: Retroperitoneal Liposarcoma Retroperitoneal sarcoma (RPS) 15% of soft tissue sarcomas (STS) 1

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Local Recurrence Growth Rate Predicts Outcome In Locally Recurrent Retroperitoneal Liposarcoma

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Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

Local Recurrence Growth Rate Predicts OutcomeIn Locally Recurrent Retroperitoneal Liposarcoma

James Park, MD, Li-Xuan Qin, PhD, Francesco Prete, MDMurray Brennan, MD, Samuel Singer, MD


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Background: Retroperitoneal Liposarcoma

  • Retroperitoneal sarcoma (RPS) 15% of soft tissue sarcomas (STS)1

  • Liposarcoma (LS) most common; 20% of all STS, up to 50% of RPS2

  • Complete resection feasible in 80% of primary RPLS3

  • Local recurrence 40~80%; local effects cause of death in 75%1,2

1. Stoeckle. Cancer 20012. Lewis. Ann Surg 19983. Singer. Ann Surg 2003


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Background: Retroperitoneal Liposarcoma

  • Gross margin, grade, and histologic subtype predict survival1,2

  • Subtype and contiguous organ resection, predict local recurrence1

  • No objective consensus to guide re-resection of local recurrence following complete resection

1. Singer. Ann Surg 20032. van Dalen. EJSO 2006


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Histologic subtype defines grade and

  • predicts local recurrence and survival in RPLS

1. Singer. Ann Surg 2003


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Purpose

  • Determine prognostic factors for survival and recurrence in patients with locally recurrent retroperitoneal liposarcoma

  • Use these factors to guide therapy and define subset of patients with locally recurrent retroperitoneal liposarcoma most likely to benefit from surgical resection


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Methods

  • Prospective sarcoma database reviewed 7/82~10/05

All STS treated N=6682

All RPS treated N=607

All RPLS treated N=355

Primary RPLS treated N=207

Complete resection N=180 (180/207 87%)

Local recurrence (LR) N=105 (105/180 58%)

Complete resection of LR N=61 (61/105 58%)


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Methods

Endpoints:

Disease-specific survival (from time of first local recurrence) for all 105 patients

Local recurrence-free survival for 61 patients re-resected

Statistics:Univariate analysis- Kaplan Meier curve and Log-rank test

Multivariate analysis- Cox’s PH model and Score test

Cut-point finding- Minimum P value method


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Results: Patient/Tumor Characteristics


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Results: Treatment characteristics


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

Tumor size (sum of max dimensions on imaging)

Time from primary resection to LR

  • Univariate Analysis of Disease-Specific Survival

  • for First LR (N=105)

Start time: First LR End point: Dead of disease

LR Growth Rate =


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Multivariate Analysis of Disease-Specific Survival

  • for First LR (N=105)


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

Tumor size (sum of max dimensions on pathology)

Time from primary resection to LR

  • Univariate Analysis of Disease-Specific Survival

  • for Complete Resection of First LR (N=61)

Start time: LR resection End point: Dead of disease

Second recurrence

LR Growth Rate =


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Multivariate Analysis of Disease-Specific Survival

  • for Complete Resection of First LR (N=61)


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Univariate Analysis of Disease-Free Survival

  • for Complete Resection of First LR (N=61)


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Multivariate Analysis of Disease-Free Survival

  • for Complete Resection of First LR (N=61)


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Finding a cutoff for LR growth rate

  • using the Minimum p value method

0.9

1. Mazumdar. Statist Med 2003


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Disease-Specific Survival by LR Growth Rate

All 105 Patients 61 Re-resected


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Resection does not improve Disease-specific survival

  • for LR Growth Rate ≥ 0.9 (N=105)


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Summary

  • LR growth rate and primary grade are independent predictors of disease-specific survival in locally recurrent RPLS

     Patients with LR growth rate ≥ 0.9 cm/month had significantly worse disease-specific survival

  • Re-resection of the recurrence did not alter the poor outcome for patients with LR growth rate ≥ 0.9 cm/month


Local recurrence growth rate predicts outcome in locally recurrent retroperitoneal liposarcoma

  • Conclusion

LR growth rate predicts disease-specific survival and local control following complete resection of locally recurrent RPLS

 Patients with LR growth rate ≥ 0.9cm/month did not benefit from aggressive operative management and should be considered for trials of novel targeted therapies


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