Annals of Surgical Oncology

, Volume 15, Issue 6, pp 1585–1593

Resectable Well-Differentiated versus Dedifferentiated Liposarcomas: Two Different Diseases Possibly Requiring Different Treatment Approaches

Authors

  • G. Lahat
    • Departments of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • D. A. Anaya
    • Departments of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • X. Wang
    • Division of Quantitative SciencesThe University of Texas MD Anderson Cancer Center
  • D. Tuvin
    • Departments of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • D. Lev
    • Cancer BiologyThe University of Texas MD Anderson Cancer Center
    • Departments of Surgical OncologyThe University of Texas MD Anderson Cancer Center
Bone and Soft Tissue Sarcomas

DOI: 10.1245/s10434-007-9805-x

Cite this article as:
Lahat, G., Anaya, D.A., Wang, X. et al. Ann Surg Oncol (2008) 15: 1585. doi:10.1245/s10434-007-9805-x

Abstract

Background

Division of retroperitoneal liposarcoma (RPLS) into well-differentiated (WD) and dedifferentiated (DD) subtypes is established; however, WD and DD are usually treated similarly. We hypothesized that WD and DD have distinct biological behaviors mandating different treatments.

Methods

A prospective sarcoma database identified all primary/recurrent RPLS treated between 1996 and 2007: 77 DD (52%) and 58 WD (39.2%) patients were analyzed for recurrence rate, recurrence free survival (RFS), and overall survival (OS).

Results

At presentation, WD were mostly primary whereas DD were mostly recurrent (75.9% versus 58.4%; p = 0.04). A significant proportion of DD (37.7%) received chemotherapy compared to WD (1.7%; p < 0.0001). Multivisceral resection was more common in DD versus WD (45.5% versus 31%; p = 0.01). Gross total resection rates were equivalent (WD: 86.2%; DD: 85.7%). Overall and local recurrence were higher in DD versus WD (82.2% versus 50% and 71.2% versus 46.3%; p < 0.0001). Only 3.7% WD recurred as high grade metastatic disease. Median time to recurrence was 55.5 months in WD versus 13.5 months in DD (p < 0.0001). RFS and OS (1, 2, and 5 year) were higher in WD than DD (80.3% versus 55.9%; 65.1% versus 34.1%; 41.9% versus 7.8%; p < 0.0001) and (98% versus 88.1%; 95.6% versus 71.9%; 92.1% versus 36.5%; p < 0.0001) respectively.

Conclusion

WD and DD have distinct biological behaviors. Gross total resection is achievable in most WD; unlike DD, high-grade recurrence is uncommon. Treatment should therefore reflect these biologic differences by maximizing survivorship while avoiding unnecessarily extensive multivisceral resection.

Synopsis

The biological behaviors of well-differentiated and dedifferentiated liposarcomas differ significantly. This article presents outcomes of two different surgical approaches that were implemented at the UTMDACC, treating these tumors as different disease entities.

Keywords

Retroperitoneal liposarcomaAtypical lipomatous tumorWell differentiationDedifferentiation

Copyright information

© Society of Surgical Oncology 2008