RETROPERITONEAL SOFT-TISSUE SARCOMA - ANALYSIS OF 500 PATIENTS TREATED AND FOLLOWED AT A SINGLE INSTITUTION

Objective To analyze treatment and survival of a large cohort of patie nts with retroperitoneal soft-tissue sarcomas (STS) treated and prospe ctively followed at a single institution. Summary Background Data Retr operitoneal STS are relatively uncommon and constitute a difficult man agement problem, Although surgical resection is often difficult or imp ossible, current chemotherapy is not effective and radiation is limite d by toxicity to adjacent structures. Thus, complete surgical resectio n remains the most effective modality for selected primary and recurre nt disease. Methods Five hundred patients with retroperitoneal STS wer e admitted and treated between July 1, 1982, and September 30, 1997, a nd prospectively followed. Patient, tumor, and treatment variables wer e analyzed for disease-specific and disease-free survival, Survival wa s determined with the Kaplan-Meier method. Statistical significance wa s evaluated using the log-rank test for univariate influence and Cox m odel stepwise regression for multivariate influence. Results Two hundr ed seventy-eight patients (56%) had primary disease and 222 (44%) recu rrent disease. Median follow-up was 28 months (range 1 to 172 months), 40 months for survivors. Median survival was 72 months for patients w ith primary disease, 28 months for those with local recurrence, and 10 months for those with metastasis. For patients with primary or locall y recurrent tumors, unresectable disease, incomplete resection, and hi gh-grade tumors significantly reduced survival time. Conclusions In th is study of patients with retroperitoneal STS, stage at presentation, high histologic grade, unresectable primary tumor, and positive gross margin are strongly associated with the tumor morality rate. Patients approached with curative intent should undergo aggressive attempts at complete surgical resection. incomplete resection should be undertaken only for symptom relief.