Influence of biologic factors and anatomic site in completely resected liposarcoma

Purpose: Soft tissue sarcoma (STS) encompasses a group of neoplasms that ar e anatomically and biologically diverse. Retroperitoneal/visceral (RP/V) tu mors have a poorer prognosis than extremity/trunk (E/T) lesions, and this h as been attributed to frequent presentation with tumors Of large size and m ultiorgan involvement that precludes complete resection. The worse prognosi s that is associated with RP/V tumors has also been thought to be histopath ologically dependent and not necessarily related to anatomic site. The aim of this study was to determine the role of anatomic site and biologic featu res in prognosis and outcome in patients after complete resection by examin ing a large cohort of STS patients with a single histopathology, ie, liposa rcoma. Methods: All patients who were treated for liposarcoma from July 1, 1982, t hrough July 1, 1998, were included, Univariate analyses were performed usin g log-rank test and Kaplan-Meier estimates, and multivariate analyses were performed using Cox regression. The three end points examined were local re currence (LR), distant recurrence, and disease-specific survival [DSS]. Results: Seven hundred twenty patients with liposarcoma were evaluated, and of these, 460 had completely resected primary or completely resected local ly recurrent disease. Breakdown of anatomic site was 65% E/T (n = 301)and 3 5% RP/V (n = 159). The median follow-up period for patients who underwent c omplete resection was 42 months (range, 1 to 194 months). We found that RP/ V site is a poor prognosticator that is independent of patient sex and age; tumor size, grade, and margin; and recurrent presentation. Sixty-nine perc ent of patients with RP/V tumors who died had local disease only and no dis tant metastasis at the time of death. Conclusion: In liposarcoma, tumor location exerts as strong an influence on prognosis as biology. In contrast to extremity liposarcoma, LR without dis tant metastasis often results in death for patients with RP/V tumors. For t hese patients, local control accomplished by complete surgical resection +/ - adjuvant radiation therapy should impact strongly on DSS. J Clin Oncol 18:1637-1643. (C) 2000 by American Society of Clinical Oncolog y.