Title

Surgery and radiotherapy for retroperitoneal and abdominal sarcoma: both necessary and sufficient

UMMS Affiliation

Department of Surgery; Department of Medicine

Date

5-19-2010

Document Type

Article

Medical Subject Headings

Cohort Studies; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Radiotherapy, Adjuvant; Retroperitoneal Neoplasms; Retrospective Studies; SEER Program; Sarcoma; Survival Rate; Treatment Outcome

Disciplines

Surgery

Abstract

OBJECTIVE: To evaluate the effect of surgical resection and radiotherapy (RT) in retroperitoneal or abdominal sarcoma.

DESIGN: Retrospective cohort.

SETTING: Surveillance, Epidemiology, and End Results, 1988-2005.

PATIENTS: Patients 18 years or older with initial diagnosis of primary retroperitoneal and nonvisceral abdominal sarcoma.

MAIN OUTCOME MEASURES: Survival for 2 years after diagnosis. Kaplan-Meier survival was stratified based on surgery and RT status. Cox proportional hazards model was used to assess adjusted effects of surgery and RT on survival in patients with locoregional disease.

RESULTS: Of 1901 patients with locoregional disease, 1547 (81.8%) underwent resection; 447 (23.5%) received RT. Overall, patients who received both surgery and RT demonstrated improved survival compared with patients who underwent either therapy alone; patients undergoing monotherapy in turn had more favorable survival compared with patients who received neither therapy (P < .001, log rank). Cox analysis demonstrated that surgical resection (hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.21-0.29; P < .001) and RT (0.78; 0.63-0.95; P = .01) independently predicted improved survival in locoregional disease only. In adjusted analyses stratified for American Joint Commission on Cancer (AJCC) stage, for stage I disease (n = 694), RT provided an additional benefit (HR, 0.49; 95% CI, 0.25-0.96; P = .04) independent of that from resection (0.35; 0.21-0.58; P < .001). For stage II/III (n = 552), resection remained protective (HR, 0.24; 95% CI, 0.18-0.32; P < .001); however, RT was no longer associated with a significant benefit (0.78; 0.58-1.06; P = .11).

CONCLUSIONS: In a national cohort of retroperitoneal and abdominal sarcomas, surgical resection was associated with significant survival benefits for AJCC disease stages I to III. Radiotherapy provided additional benefit for patients with stage I disease. Resection should be offered to reasonable surgical candidates with nonmetastatic retroperitoneal/abdominal sarcomas; radiotherapy may most benefit patients with early-stage disease.

Rights and Permissions

Citation: Arch Surg. 2010 May;145(5):426-31. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

20479339