Prognostic factors in retroperitoneal sarcoma - A multivariate analysis ofa series of 165 patients of the French Cancer Center Federation Sarcoma Group

BACKGROUND. Surgery is the main prognostic factor in retroperitoneal sarcom a. However, despite progress, surgery alone is rarely curative, and analysi s of the causes of failures and of other prognostic factors are warranted t o ascertain treatment orientations. METHODS. Data of patients treated from 1.80 to 12.94 for primary retroperit oneal sarcoma were extracted from the French Federation of Cancer Centers S arcoma Group registry. Univariate and multivariate analysis were performed for initial local control and for local and general outcome. One hundred si xty-five patients (median age, 54 years; range, 16-82 years] were identifie d. Median tumor size was 15 cm (range, 2-70 cm); 31% of tumors presented wi th neurovascular or bone involvement. Liposarcoma, leiomyosarcoma, and mali gnant fibrous histiocytoma represented 66% of the tumors. Eighty-four perce nt of the tumors were of high or intermediate grade. Twenty patients had in itial metastases. Multimodality treatment included surgery (150 patients), radiotherapy (92 patients), and chemotherapy (77 patients). Complete excisi on was achieved in 94 of 145 nonmetastatic patients. Median follow-up was 4 7 months (range, 3-160 months). RESULTS. Actuarial overall 5-year survival rate (median) was 46% (51 months ). The main prognostic factors for survival were initial metastases and sur gery, which represented the major treatment-linked factor. High-grade of tu mors affected local recurrence, metastatic recurrence, and survival. Adjuva nt radiotherapy was significantly associated with reduced local recurrence. Various evolutive patterns were observed with histologic subtypes. CONCLUSIONS. Aggressive surgery remains mandatory in retroperitoneal sarcom a. but a randomized trial is needed to evaluate the place of radiotherapy f or local control. (C) 2001 Americnn Cancer Society.