Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)?
Background/Objectives For various reasons, some patients undergo a gross margin positive resection (R2) leading to a dilemma in care. We hypothesized that there is a subset of patients who have long‐term survival (LTS, ≥5 years) after R2 resection for retroperitoneal sarcoma (RPS). Methods National...
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| Veröffentlicht in: | Journal of surgical oncology 2016-06, Vol.113 (7), p.823-827 |
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| container_title | Journal of surgical oncology |
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| creator | Klooster, Brittany Rajeev, Rahul Chrabaszcz, Sarah Charlson, John Miura, John Bedi, Meena Gamblin, Thomas Clark Johnston, Fabian Turaga, Kiran K. |
| description | Background/Objectives
For various reasons, some patients undergo a gross margin positive resection (R2) leading to a dilemma in care. We hypothesized that there is a subset of patients who have long‐term survival (LTS, ≥5 years) after R2 resection for retroperitoneal sarcoma (RPS).
Methods
National Cancer Database data from 1998 to 2011 were reviewed to identify patients with RPS who had R2 resections. Logistic and Cox regression models were used to compare LTS with short‐term survival.
Results
Of 12,028 patients, R2 resection rate was 3.28% (4.9% in 1998; 2.5% in 2011). Median survival for RPS with R2 resection was 21 months versus 69 months for those with R0/R1 resections (P |
| doi_str_mv | 10.1002/jso.24232 |
| format | Article |
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For various reasons, some patients undergo a gross margin positive resection (R2) leading to a dilemma in care. We hypothesized that there is a subset of patients who have long‐term survival (LTS, ≥5 years) after R2 resection for retroperitoneal sarcoma (RPS).
Methods
National Cancer Database data from 1998 to 2011 were reviewed to identify patients with RPS who had R2 resections. Logistic and Cox regression models were used to compare LTS with short‐term survival.
Results
Of 12,028 patients, R2 resection rate was 3.28% (4.9% in 1998; 2.5% in 2011). Median survival for RPS with R2 resection was 21 months versus 69 months for those with R0/R1 resections (P < 0.001). Of 272 patients with available survival, 24% (n = 64) survived ≥5 years with 64% alive at follow‐up. LTS was most often seen in younger patients (<65 years) with well‐differentiated liposarcoma. Chemotherapy appeared to improve survival in the first 3 postoperative years, but paradoxical effects were seen in LTS (Hazards Ratio [HR] 0.69, 95%CI: 0.50–0.95, P = 0.024) in first 3 years versus (HR 2.15, 95%CI: 1.21–3.81, P = 0.009).
Conclusion
Long‐term survival is possible for a subset of patients after an R2 resection for RPS, especially with favorable histology characteristics. Benefits of chemotherapy in margin positive settings need to be investigated. J. Surg. Oncol. 2016;113:823–827. © 2016 Wiley Periodicals, Inc.</description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.24232</identifier><identifier>PMID: 27060344</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents - therapeutic use ; Chemotherapy ; Chemotherapy, Adjuvant ; clinicopathological factors ; Databases, Factual ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Male ; Margins of Excision ; Middle Aged ; Prognosis ; prognostic factor ; resection margins ; Retroperitoneal Neoplasms - drug therapy ; Retroperitoneal Neoplasms - mortality ; Retroperitoneal Neoplasms - pathology ; Retroperitoneal Neoplasms - surgery ; retroperitoneal sarcoma ; Retrospective Studies ; Sarcoma - drug therapy ; Sarcoma - mortality ; Sarcoma - pathology ; Sarcoma - surgery ; Survival Analysis</subject><ispartof>Journal of surgical oncology, 2016-06, Vol.113 (7), p.823-827</ispartof><rights>2016 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3912-3571a4a94784aec5be4021b47ceb490d0b29bd31669d64b121f7a5f3430958943</citedby><cites>FETCH-LOGICAL-c3912-3571a4a94784aec5be4021b47ceb490d0b29bd31669d64b121f7a5f3430958943</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjso.24232$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjso.24232$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27060344$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Klooster, Brittany</creatorcontrib><creatorcontrib>Rajeev, Rahul</creatorcontrib><creatorcontrib>Chrabaszcz, Sarah</creatorcontrib><creatorcontrib>Charlson, John</creatorcontrib><creatorcontrib>Miura, John</creatorcontrib><creatorcontrib>Bedi, Meena</creatorcontrib><creatorcontrib>Gamblin, Thomas Clark</creatorcontrib><creatorcontrib>Johnston, Fabian</creatorcontrib><creatorcontrib>Turaga, Kiran K.</creatorcontrib><title>Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)?</title><title>Journal of surgical oncology</title><addtitle>J. Surg. Oncol</addtitle><description>Background/Objectives
For various reasons, some patients undergo a gross margin positive resection (R2) leading to a dilemma in care. We hypothesized that there is a subset of patients who have long‐term survival (LTS, ≥5 years) after R2 resection for retroperitoneal sarcoma (RPS).
Methods
National Cancer Database data from 1998 to 2011 were reviewed to identify patients with RPS who had R2 resections. Logistic and Cox regression models were used to compare LTS with short‐term survival.
Results
Of 12,028 patients, R2 resection rate was 3.28% (4.9% in 1998; 2.5% in 2011). Median survival for RPS with R2 resection was 21 months versus 69 months for those with R0/R1 resections (P < 0.001). Of 272 patients with available survival, 24% (n = 64) survived ≥5 years with 64% alive at follow‐up. LTS was most often seen in younger patients (<65 years) with well‐differentiated liposarcoma. Chemotherapy appeared to improve survival in the first 3 postoperative years, but paradoxical effects were seen in LTS (Hazards Ratio [HR] 0.69, 95%CI: 0.50–0.95, P = 0.024) in first 3 years versus (HR 2.15, 95%CI: 1.21–3.81, P = 0.009).
Conclusion
Long‐term survival is possible for a subset of patients after an R2 resection for RPS, especially with favorable histology characteristics. Benefits of chemotherapy in margin positive settings need to be investigated. J. Surg. Oncol. 2016;113:823–827. © 2016 Wiley Periodicals, Inc.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant</subject><subject>clinicopathological factors</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>prognostic factor</subject><subject>resection margins</subject><subject>Retroperitoneal Neoplasms - drug therapy</subject><subject>Retroperitoneal Neoplasms - mortality</subject><subject>Retroperitoneal Neoplasms - pathology</subject><subject>Retroperitoneal Neoplasms - surgery</subject><subject>retroperitoneal sarcoma</subject><subject>Retrospective Studies</subject><subject>Sarcoma - drug therapy</subject><subject>Sarcoma - mortality</subject><subject>Sarcoma - pathology</subject><subject>Sarcoma - surgery</subject><subject>Survival Analysis</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1P3DAQhq2qqCxLD_wBFKkXOATGH4njU1WtYJcFla9WPRonO0FeknhrJ0v59zUscKjU08gzz_vKegjZo3BEAdjxMrgjJhhnH8iIgspTBar4SEbxxlIhFWyTnRCWAKBULj6RbSYhBy7EiNydhaRx3X3ao2-TMPi1XZsmWbkQbNlgYup4SFrj722Xxq3t7RoTjwGr3roucXV89N6t0NvedRizwfjKtSY5uLm6Pfy6S7Zq0wT8_DrH5OfpyY_JLL24nJ5Nvl2kFVeUpTyT1AijhCyEwSorUQCjpZAVlkLBAkqmygWnea4WuSgpo7U0Wc0FB5UVSvAxOdj0rrz7PWDodWtDhU1jOnRD0DRqEJnKFET0yz_o0g2-i797oSAvRPFceLihKh9leKz1ytso4klT0M_addSuX7RHdv-1cShbXLyTb54jcLwBHm2DT_9v0vPby7fKdJOwocc_7wnjH3Quucz0r-9TfT6fFNezDLTkfwHkhJnx</recordid><startdate>201606</startdate><enddate>201606</enddate><creator>Klooster, Brittany</creator><creator>Rajeev, Rahul</creator><creator>Chrabaszcz, Sarah</creator><creator>Charlson, John</creator><creator>Miura, John</creator><creator>Bedi, Meena</creator><creator>Gamblin, Thomas Clark</creator><creator>Johnston, Fabian</creator><creator>Turaga, Kiran K.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201606</creationdate><title>Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)?</title><author>Klooster, Brittany ; Rajeev, Rahul ; Chrabaszcz, Sarah ; Charlson, John ; Miura, John ; Bedi, Meena ; Gamblin, Thomas Clark ; Johnston, Fabian ; Turaga, Kiran K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3912-3571a4a94784aec5be4021b47ceb490d0b29bd31669d64b121f7a5f3430958943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant</topic><topic>clinicopathological factors</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Margins of Excision</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>prognostic factor</topic><topic>resection margins</topic><topic>Retroperitoneal Neoplasms - drug therapy</topic><topic>Retroperitoneal Neoplasms - mortality</topic><topic>Retroperitoneal Neoplasms - pathology</topic><topic>Retroperitoneal Neoplasms - surgery</topic><topic>retroperitoneal sarcoma</topic><topic>Retrospective Studies</topic><topic>Sarcoma - drug therapy</topic><topic>Sarcoma - mortality</topic><topic>Sarcoma - pathology</topic><topic>Sarcoma - surgery</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Klooster, Brittany</creatorcontrib><creatorcontrib>Rajeev, Rahul</creatorcontrib><creatorcontrib>Chrabaszcz, Sarah</creatorcontrib><creatorcontrib>Charlson, John</creatorcontrib><creatorcontrib>Miura, John</creatorcontrib><creatorcontrib>Bedi, Meena</creatorcontrib><creatorcontrib>Gamblin, Thomas Clark</creatorcontrib><creatorcontrib>Johnston, Fabian</creatorcontrib><creatorcontrib>Turaga, Kiran K.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Klooster, Brittany</au><au>Rajeev, Rahul</au><au>Chrabaszcz, Sarah</au><au>Charlson, John</au><au>Miura, John</au><au>Bedi, Meena</au><au>Gamblin, Thomas Clark</au><au>Johnston, Fabian</au><au>Turaga, Kiran K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)?</atitle><jtitle>Journal of surgical oncology</jtitle><addtitle>J. Surg. Oncol</addtitle><date>2016-06</date><risdate>2016</risdate><volume>113</volume><issue>7</issue><spage>823</spage><epage>827</epage><pages>823-827</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><abstract>Background/Objectives
For various reasons, some patients undergo a gross margin positive resection (R2) leading to a dilemma in care. We hypothesized that there is a subset of patients who have long‐term survival (LTS, ≥5 years) after R2 resection for retroperitoneal sarcoma (RPS).
Methods
National Cancer Database data from 1998 to 2011 were reviewed to identify patients with RPS who had R2 resections. Logistic and Cox regression models were used to compare LTS with short‐term survival.
Results
Of 12,028 patients, R2 resection rate was 3.28% (4.9% in 1998; 2.5% in 2011). Median survival for RPS with R2 resection was 21 months versus 69 months for those with R0/R1 resections (P < 0.001). Of 272 patients with available survival, 24% (n = 64) survived ≥5 years with 64% alive at follow‐up. LTS was most often seen in younger patients (<65 years) with well‐differentiated liposarcoma. Chemotherapy appeared to improve survival in the first 3 postoperative years, but paradoxical effects were seen in LTS (Hazards Ratio [HR] 0.69, 95%CI: 0.50–0.95, P = 0.024) in first 3 years versus (HR 2.15, 95%CI: 1.21–3.81, P = 0.009).
Conclusion
Long‐term survival is possible for a subset of patients after an R2 resection for RPS, especially with favorable histology characteristics. Benefits of chemotherapy in margin positive settings need to be investigated. J. Surg. Oncol. 2016;113:823–827. © 2016 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>27060344</pmid><doi>10.1002/jso.24232</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Antineoplastic Agents - therapeutic use Chemotherapy Chemotherapy, Adjuvant clinicopathological factors Databases, Factual Female Follow-Up Studies Humans Logistic Models Male Margins of Excision Middle Aged Prognosis prognostic factor resection margins Retroperitoneal Neoplasms - drug therapy Retroperitoneal Neoplasms - mortality Retroperitoneal Neoplasms - pathology Retroperitoneal Neoplasms - surgery retroperitoneal sarcoma Retrospective Studies Sarcoma - drug therapy Sarcoma - mortality Sarcoma - pathology Sarcoma - surgery Survival Analysis |
| title | Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)? |
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