Annals of Surgical Oncology

, Volume 15, Issue 6, pp 1585–1593 | Cite as

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

  • G. Lahat
  • D. A. Anaya
  • X. Wang
  • D. Tuvin
  • D. Lev
  • R. E. Pollock
Bone and Soft Tissue Sarcomas

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 liposarcoma Atypical lipomatous tumor Well differentiation Dedifferentiation 

References

  1. 1.
    Dei Tos AP. Liposarcoma: new entities and evolving concepts. Ann Diagn Pathol 2000; 4:252–66PubMedCrossRefGoogle Scholar
  2. 2.
    Linehan DC, Lewis JJ, Leung D, et al. Influence of biologic factors and anatomic site in completely resected liposarcoma. J Clin Oncol 2000;18: 1637–43PubMedGoogle Scholar
  3. 3.
    Mack T. Sarcomas and other malignancies of soft tissue, retroperitoneum, peritoneum, pleura, heart, mediastinum, and spleen. Cancer 1995; 75:211–44PubMedCrossRefGoogle Scholar
  4. 4.
    Enzinger FM, Weiss SW. Liposarcoma: soft tissue tumors, 3rd ed. St. Louis: CV Mosby, 2001Google Scholar
  5. 5.
    Fletcher CDM, Unni K, Mertens F. Pathology and genetics of tumours of soft tissue and bone. Lyon, France: International Agency for Research on Cancer (IARC), 2002Google Scholar
  6. 6.
    Evans HL. Liposarcoma. A study of 55 cases with a reassessment of its classification. Am J Surg Pathol 1979; 3:507–23PubMedCrossRefGoogle Scholar
  7. 7.
    Fabre-Guillevin E, Tabrizi R, Coulon V, et al. Retroperitoneal liposarcomas: follow-up analysis of dedifferentiation after clinicopathologic reexamination of 86 liposarcomas and malignant fibrous histiocytomas. Cancer 2006; 106:2725–33PubMedCrossRefGoogle Scholar
  8. 8.
    Neuhaus SJ, Barry P, Clark MA, et al. Surgical management of primary and recurrent retroperitoneal liposarcoma. Br J Surg 2005;92:246–52PubMedCrossRefGoogle Scholar
  9. 9.
    Gronchi A, Casali PG, Fiore M, et al. Retroperitoneal soft tissue sarcomas: patterns of recurrence in 167 patients treated at a single institution. Cancer 2004;100:2448–55PubMedCrossRefGoogle Scholar
  10. 10.
    LinehanDC, Lewis JJ, Leung D, et al. Influence of biologic factors and anatomic site in completely resected liposarcoma. J Clin Oncol 2000;18:1637–43Google Scholar
  11. 11.
    Singer S, Antonescu CR, Riedel E, et al. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg 2003; 238:358–70PubMedGoogle Scholar
  12. 12.
    Kaplan EL, Meier P. Nonparametric estimator from incomplete observations. J Am Stat Assoc 1958; 53:457–81CrossRefGoogle Scholar
  13. 13.
    Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemotherapy Rep 1966; 60:163–70Google Scholar
  14. 14.
    Cox DR. Regression models and life tables (with discussion). J R Stat Soc B 1972; 34:187–220Google Scholar
  15. 15.
    Venables WN, Ripley BD. Modern applied statistics with Splus, 3rd ed. New York, Springer, 1999Google Scholar
  16. 16.
    Bautista N, Su W, O’Connell TX. Retroperitoneal soft-tissue sarcomas: prognosis and treatment of primary and recurrent disease. Am Surg 2000; 66:832–6PubMedGoogle Scholar
  17. 17.
    Malerba M, Doglietto GB, Pacelli F, et al. Primary retroperitoneal soft tissue sarcomas: results of aggressive surgical treatment. World J Surg 1999; 23:670–5PubMedCrossRefGoogle Scholar
  18. 18.
    Gutierrez JC, Perez EA, Franceschi D, et al. Outcomes for soft-tissue sarcoma in 8249 cases from a large state cancer registry. J Surg Res 2007;141:105–14PubMedCrossRefGoogle Scholar
  19. 19.
    An JY, Heo JS, Noh JH, et al. Primary malignant retroperitoneal tumors: analysis of a single institutional experience. Eur J Surg Oncol 2007;33:376–82PubMedCrossRefGoogle Scholar
  20. 20.
    Evans HL. Atypical lipomatous tumor, its variants, and its combined forms: a study of 61 cases, with a minimum follow-up of 10 years. Am J Surg Pathol 2007;31:1–14PubMedCrossRefGoogle Scholar
  21. 21.
    Singer S, Corson JM, Demetri GD, et al. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg 1995;221:185–95PubMedCrossRefGoogle Scholar
  22. 22.
    Karakousis CP, Gerstenbluth R, Kontzoglou K, et al. Retroperitoneal sarcomas and their management. Arch Surg 1995;130:1104–9PubMedGoogle Scholar
  23. 23.
    Erzen D, Sencar M, Novak J. Retroperitoneal sarcoma: 25 years of experience with aggressive surgical treatment at the Institute of Oncology, Ljubljana. J Surg Oncol 2005;91:1–9PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • G. Lahat
    • 1
  • D. A. Anaya
    • 1
  • X. Wang
    • 2
  • D. Tuvin
    • 1
  • D. Lev
    • 3
  • R. E. Pollock
    • 1
  1. 1.Departments of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
  2. 2.Division of Quantitative SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexas
  3. 3.Cancer BiologyThe University of Texas MD Anderson Cancer CenterHoustonTexas

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