原发性腹膜后脂肪肉瘤预后及复发因素分析

Analysis of prognosis and recurrent factors of primary retroperitoneal liposarcoma

    摘要
  • 摘要: 目的:探讨影响原发性腹膜后脂肪肉瘤(PRPLS)患者预后及复发的相关因素。
    方法:采用回顾性病例对照研究方法。收集2005年1月至2015年3月第三军医大学西南医院收治的51例PRPLS患者的临床病理资料。观察指标：(1)随访情况。(2)预后因素分析：性别、年龄、肿瘤直径、行联合脏器切除术、病理学类型、肿瘤危险度、局部复发。(3)复发危险因素分析：性别、年龄、肿瘤直径、行联合脏器切除术、病理学类型、肿瘤危险度。(4)分层分析：对复发独立危险因素进行分层分析。(5)肿瘤危险度与肿瘤直径、侵犯脏器数目的相关性。(6)邻近脏器侵犯与肿瘤直径的相关性。采用门诊和电话方式进行随访，了解患者生存及肿瘤复发情况。随访时间截至2015年10月。采用KaplanMeier法计算生存率和绘制生存曲线，采用Logrank检验进行单因素分析和生存分析，采用COX回归模型进行多因素分析。采用 Pearson检验进行相关性分析。
    结果:(1)随访情况：51例患者均获得术后随访，随访时间为3～114个月，中位随访时间为43个月。51例患者3年生存率为70.6%。22例出现第1次局部复发，复发时间为3～ 60个月，中位复发时间为29个月。(2)预后因素分析：单因素分析结果显示：肿瘤直径、行联合脏器切除术、病理学类型、肿瘤危险度、局部复发是影响PRPLS患者预后的相关因素(χ2=5.926，4.936，17.856，17.279，14.568，P<0.05)。多因素分析结果显示：行联合脏器切除术、病理学类型、肿瘤危险度是影响 PRPLS患者预后的独立因素(OR=0.538，0.645，9.620，95%可信区间：0.238～0.997，0.458～1.058，1.692～18.714，P<0.05)。(3)复发危险因素分析：单因素分析结果显示：病理学类型、肿瘤危险度是影响PRPLS患者复发的相关因素(χ2=12.375，12.364，P<0.05)。多因素分析结果显示：肿瘤危险度是影响PRPLS患者复发的独立因素(OR=6.234，95%可信区间：1.419～27.377，P<0.05)。(4)分层分析：11例低危险度PRPLS复发患者3年生存率为63.6%，11例高危险度PRPLS复发患者3年生存率为9.1%，两者生存情况比较，差异有统计学意义(χ2=12.364，P<0.05)。(5)肿瘤危险度与肿瘤直径、侵犯脏器数目的相关性：33例低危险度PRPLS患者肿瘤直径为(17±8)cm，侵犯脏器数目为(1±1)个；18例高危险度PRPLS患者肿瘤直径为 (19±5)cm，侵犯脏器数目为(2±1)个。两者肿瘤直径比较，差异无统计学意义(r=0.222，P>0.05)；两者侵犯脏器数目比较，差异有统计学意义(r=0.666，P<0.05)。(6)邻近脏器侵犯与肿瘤直径的相关性：19例无邻近脏器侵犯PRPLS患者肿瘤直径为(16±8)cm，32例有邻近脏器侵犯PRPLS患者肿瘤直径为(19±7)cm，两者比较，差异无统计学意义(r=0.225，P>0.05)。
    结论:行联合脏器切除术、病理学类型、肿瘤危险度是影响PRPLS患者预后的独立因素；肿瘤危险度是影响PRPLS患者复发的独立因素。低危险度PRPLS复发患者预后优于高危险度PRPLS复发患者。高危险度PRPLS患者更易侵犯脏器。

     

    Abstract: Objective:To investigate the prognosis and recurrent factors of primary retroperitoneal liposarcoma (PRPLS).
    Methods:The retrospective casecontrol study was conducted. The clinicopathological data of 51 patients with PRPLS who were admitted to the Southwest Hospital of the Third Military Medical University from January 2005 and March 2015 were collected. Observation indicators: (1) followup institution. (2) Analysis of prognostic factors: gender, age, tumor diameter, combined organs resection, pathological type, cancer risk and local recurrence. (3) Analysis of recurrent risk factors: gender, age, tumor diameter, combined organs resection, pathological type and cancer risk. (4) Stratified analysis: the independent risk factors of recurrence were done by the stratified analysis. (5) Correlation between cancer risk and tumor diameter or number of organs invaded. (6) Correlation between adjacent organ invasion and tumor diameter. Followup using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence up to October 2015. The survival rate and curve were respectively calculated and drawn by KaplanMeier method. The univariate analysis and survival analysis were done using the Logrank test. The multivariate analysis was done by the COX regression model. The correlation analysis was done using the Pearson test.
    Results: (1) Followup institution: 51 patients were followed up for 3-114 months, with a median time of 43 months. The 3year survival rate of 51 patients was 70.6%. Twentytwo patients had the first local recurrence, with a recurrent time of 3-60 months and a median time of 29 months. (2)Analysis of prognostic factors: the results of univariate analysis showed that tumor diameter, combined organs resection, pathological type, cancer risk and local recurrence were the related factors affecting prognosis of patients with PRPLS (χ2=5.926, 4.936, 17.856, 17.279, 14.568, P<0.05). The results of multivariate analysis showed that combined organs resection, pathological type and cancer risk were the independent factors affecting prognosis of patients with PRPLS ［OR=0.538, 0.645, 9.620, 95% confidence interval (CI): 0.238-0.997, 0.458-1.058, 1.692-18.714, P<0.05］. (3) Analysis of recurrent risk factors: the results of univariate analysis showed that pathological type and cancer risk were the related factors affecting recurrence of patients with PRPLS (χ2=12.375, 12.364, P<0.05). The results of multivariate analysis showed that cancer risk was an independent factor affecting recurrence of patients with PRPLS (OR=6.234, 95%CI: 1.419-27.377, P<0.05). (4) Stratified analysis: the 3year survival rates of 11 patients with low risk of recurrence of PRPLS and with high risk of recurrence of PRPLS were 63.6% and 9.1%, respectively, with a statistically significant difference (χ2=12.364, P<0.05). (5) Correlation between cancer risk and tumor diameter or number of organs invaded. Tumor diameter and number of organs invaded were respectively (17±8)cm, 1±1 in 33 patients with low risk of PRPLS and (19±5)cm, 2±1 in 18 patients with high risk of PRPLS, with no statistically significant difference in tumor diameter (r=0.222, P>0.05) and with a statistically significant difference in number of organs invaded (r=0.666, P<0.05). (6) Correlation between adjacent organ invasion and tumor diameter. Tumor diameter was (16±8)cm in 19 patients without adjacent organ invasion and (19±7)cm in 32 patients with adjacent organ invasion, respectively, showing no statistically significant difference (r=0.225, P>0.05).
    Conclusions:The combined organs resection, pathological type and cancer risk are independent factors affecting prognosis of patients with PRPLS, and cancer risk is an independent factor affecting recurrence of patients with PRPLS. The prognosis of patients with low risk of PRPLS is better than that with high risk of PRPLS. The organ invaded is much likely to occur in patients with high risk of PRPLS.

     

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