Optimal treatment strategy for paratesticular liposarcoma: retrospective analysis of 265 reported cases.
Adjuvant radiation
High inguinal orchiectomy
Liposarcoma
Paratesticular
Surgical margin
Journal
International journal of clinical oncology
ISSN: 1437-7772
Titre abrégé: Int J Clin Oncol
Pays: Japan
ID NLM: 9616295
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
22
05
2020
accepted:
17
07
2020
pubmed:
28
7
2020
medline:
15
1
2021
entrez:
28
7
2020
Statut:
ppublish
Résumé
Liposarcoma is one of the most common subtypes of soft tissue sarcoma. Although the standard treatment for localized liposarcoma is surgical resection with negative margins, a treatment specific to paratesticular liposarcoma has yet to be quantitatively evaluated. A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular liposarcoma published between 1979 and 2018 in English. The final cohort included 265 patients in 183 articles. The starting point was the time of surgical treatment, and the endpoint was the time of recurrence, including local recurrence, or distant metastasis. The median patient age was 62 years and the median tumor size was 9.5 cm. In total, 178 patients underwent high inguinal orchiectomy and 40 underwent simple tumorectomy. Based on the Kaplan-Meier curves, recurrence-free survival rates were significantly higher for those who underwent high inguinal orchiectomy than for those who underwent tumorectomy. Moreover, those with microscopic positive margins had a higher risk of recurrence than those with negative margins, but adjuvant radiation therapy after resection had no statistically significant effect on recurrence-free survival, even in subgroup analysis of patients with positive margins. Regarding the pathological subtypes, dedifferentiated, pleomorphic, and round-cell liposarcoma had a higher risk of recurrence than well-differentiated or myxoid liposarcoma. In the multivariate analysis, high inguinal orchiectomy greatly affected recurrence-free survival. The tumor size and histological subtype were independent risk factors for recurrence. Complete resection with high inguinal orchiectomy is the optimal treatment for paratesticular liposarcoma.
Sections du résumé
BACKGROUND
BACKGROUND
Liposarcoma is one of the most common subtypes of soft tissue sarcoma. Although the standard treatment for localized liposarcoma is surgical resection with negative margins, a treatment specific to paratesticular liposarcoma has yet to be quantitatively evaluated.
METHODS
METHODS
A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular liposarcoma published between 1979 and 2018 in English. The final cohort included 265 patients in 183 articles. The starting point was the time of surgical treatment, and the endpoint was the time of recurrence, including local recurrence, or distant metastasis.
RESULTS
RESULTS
The median patient age was 62 years and the median tumor size was 9.5 cm. In total, 178 patients underwent high inguinal orchiectomy and 40 underwent simple tumorectomy. Based on the Kaplan-Meier curves, recurrence-free survival rates were significantly higher for those who underwent high inguinal orchiectomy than for those who underwent tumorectomy. Moreover, those with microscopic positive margins had a higher risk of recurrence than those with negative margins, but adjuvant radiation therapy after resection had no statistically significant effect on recurrence-free survival, even in subgroup analysis of patients with positive margins. Regarding the pathological subtypes, dedifferentiated, pleomorphic, and round-cell liposarcoma had a higher risk of recurrence than well-differentiated or myxoid liposarcoma. In the multivariate analysis, high inguinal orchiectomy greatly affected recurrence-free survival. The tumor size and histological subtype were independent risk factors for recurrence.
CONCLUSION
CONCLUSIONS
Complete resection with high inguinal orchiectomy is the optimal treatment for paratesticular liposarcoma.
Identifiants
pubmed: 32715355
doi: 10.1007/s10147-020-01753-3
pii: 10.1007/s10147-020-01753-3
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2099-2106Commentaires et corrections
Type : CommentIn
Références
Siegel RL, Miller KD, Jemal A (2020) Cancer statistics, 2020. CA Cancer J Clin 70(1):7–30
doi: 10.3322/caac.21590
Crago AM, Brennan MF (2015) Principles in management of soft tissue sarcoma. Adv Surg 49(1):107–122
doi: 10.1016/j.yasu.2015.04.002
Murphey MD (2007) World Health Organization classification of bone and soft tissue tumors: modifications and implications for radiologists. Semin Musculoskelet Radiol 11(3):201–214
doi: 10.1055/s-2008-1038310
Coleman J, Brennan MF, Alektiar K et al (2003) Adult spermatic cord sarcomas: management and results. Ann Surg Oncol 10(9):669–675
doi: 10.1245/ASO.2003.11.014
Ballo MT, Zagars GK, Pisters PW et al (2001) Spermatic cord sarcoma: outcome, patterns of failure and management. J Urol 166(4):1306–1310
doi: 10.1016/S0022-5347(05)65758-8
Fagundes MA, Zietman AL, Althausen AF et al (1996) The management of spermatic cord sarcoma. Cancer 77(9):1873–1876
doi: 10.1002/(SICI)1097-0142(19960501)77:9<1873::AID-CNCR17>3.0.CO;2-X
Russo P, Brady MS, Conlon K et al (1992) Adult urological sarcoma. J Urol 147(4):1032–1036
doi: 10.1016/S0022-5347(17)37456-6
Rodríguez D, Barrisford GW, Sanchez A et al (2014) Primary spermatic cord tumors: disease characteristics, prognostic factors, and treatment outcomes. Urol Oncol 32(1):52.e19–25
doi: 10.1016/j.urolonc.2013.08.009
Fletcher CDM, Bridge JA, Hogendoorn PCW, et al. (eds) (2013) World health organization classification of tumours of soft tissue and bone, 4th edn. IARC Press, Lyon
Evans HL (1979) Liposarcoma: a study of 55 cases with a reassessment of its classification. Am J Surg Pathol 3(6):507–523
doi: 10.1097/00000478-197912000-00004
Dalal KM, Antonescu CR, Singer S (2008) Diagnosis and management of lipomatous tumors. J Surg Oncol 97(4):298–313
doi: 10.1002/jso.20975
Dalal KM, Kattan MW, Antonescu CR et al (2006) Subtype specific prognostic nomogram for patients with primary liposarcoma of the retroperitoneum, extremity, or trunk. Ann Surg 244(3):381–391
pubmed: 16926564
pmcid: 1856537
Clark MA, Fisher C, Judson I et al (2005) Soft-tissue sarcomas in adults. N Engl J Med 353(7):701–711
doi: 10.1056/NEJMra041866
Dangoor A, Seddon B, Gerrand C et al (2016) UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 6:20
doi: 10.1186/s13569-016-0060-4
López-Pousa A, Martin Broto J, Martinez Trufero J et al (2016) SEOM Clinical Guideline of management of soft-tissue sarcoma (2016). Clin Transl Oncol 18(12):1213–1220
doi: 10.1007/s12094-016-1574-1
von Mehren M, Randall RL, Benjamin RS et al (2018) Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 16(5):536–563
doi: 10.6004/jnccn.2018.0025
Keenan RA, Nic An Riogh AU, Stroiescu A et al (2019) Paratesticular sarcomas: a case series and literature review. Ther Adv Urol 11:1756287218818029
doi: 10.1177/1756287218818029
Khoubehi B, Mishra V, Ali M et al (2002) Adult paratesticular tumours. BJU Int 90(7):707–715
doi: 10.1046/j.1464-410X.2002.02992.x
Radaelli S, Desai A, Hodson J et al (2014) Prognostic factors and outcome of spermatic cord sarcoma. Ann Surg Oncol 21(11):3557–3563
doi: 10.1245/s10434-014-3751-1
Catton C, Jewett M, O’Sullivan B et al (1999) Paratesticular sarcoma: failure pattern after definitive local therapy. J Urol 161(6):1844–1847
doi: 10.1016/S0022-5347(05)68823-4
Brooks AD, Bowne WB, Delgado R et al (2001) Soft tissue sarcomas of the groin: diagnosis, management, and prognosis. J Am Coll Surg 193(2):130–136
doi: 10.1016/S1072-7515(01)00982-6
Rabbani F, Wright JE, McLoughlin MG (1997) Sarcomas of the spermatic cord: significance of wide local excision. Can J Urol 4(2):366–376
pubmed: 12735853
Pisters PW, Leung DH, Woodruff J et al (1996) Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 14(5):1679–1689
doi: 10.1200/JCO.1996.14.5.1679
Knebel C, Lenze U, Pohlig F et al (2017) Prognostic factors and outcome of Liposarcoma patients: a retrospective evaluation over 15 years. BMC Cancer 17(1):410
doi: 10.1186/s12885-017-3398-y
Khandekar MJ, Raut CP, Hornick JL et al (2013) Paratesticular liposarcoma: unusual patterns of recurrence and importance of margins. Ann Surg Oncol 20(7):2148–2155
doi: 10.1245/s10434-013-2963-0
Murray KS, Vertosick EA, Spaliviero M et al (2018) Importance of wide re-resection in adult spermatic cord sarcomas: report on oncologic outcomes at a single institution. J Surg Oncol 117(7):1464–1468
doi: 10.1002/jso.25016
Hazariwala R, Morris CG, Gilbert S et al (2013) Radiotherapy for spermatic cord sarcoma. Am J Clin Oncol 36(4):392–394
doi: 10.1097/COC.0b013e318248dc51
Trovik LH, Ovrebo K, Almquist M et al (2014) Adjuvant radiotherapy in retroperitoneal sarcomas. A Scandinavian Sarcoma Group study of 97 patients. Acta Oncol 53(9):1165–1172
doi: 10.3109/0284186X.2014.921723
Yang JC, Chang AE, Baker AR et al (1998) Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 16(1):197–203
doi: 10.1200/JCO.1998.16.1.197
Chung PW, Deheshi BM, Ferguson PC et al (2009) Radiosensitivity translates into excellent local control in extremity myxoid liposarcoma: a comparison with other soft tissue sarcomas. Cancer 115(14):3254–3261
doi: 10.1002/cncr.24375
de Vreeze RS, de Jong D, Haas RL et al (2008) Effectiveness of radiotherapy in myxoid sarcomas is associated with a dense vascular pattern. Int J Radiat Oncol Biol Phys 72(5):1480–1487
doi: 10.1016/j.ijrobp.2008.03.008