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Analysis of Differentiation Changes and Outcomes at Time of First Recurrence of Retroperitoneal Liposarcoma by Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG)

A Correction to this article was published on 19 March 2022

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Local recurrence following resection of retroperitoneal liposarcoma (RLPS) is common. Well-differentiated (WD) and dedifferentiated (DD) RLPS are distinct entities with differing outcomes. A few reports suggest that WDLPS can recur as DDLPS and that DDLPS can recur as WDLPS. This study evaluates whether this change in differentiation from the primary tumor to the first local recurrence impacts long-term outcomes.


Retrospective review from 22 sarcoma centers identified consecutive patients who underwent resection for a first locally recurrent RLPS from January 2002 to December 2011. Outcomes measured included overall survival, local recurrence, and distant metastasis.


A total of 421 RPLS patients were identified. Of the 230 patients with primary DDLPS, 34 (15%) presented WDLPS upon recurrence (DD → WD); and of the 191 patients with primary WDLPS, 54 (28%) presented DDLPS upon recurrence (WD → DD). The 6-year overall survival probabilities (95% CI) for DD → DD, DD → WD, WD → WD, and WD → DD were 40% (32–48%), 73% (58–92%), 76% (68–85%), and 56% (43–73%) (p < 0.001), respectively. The 6-year second local recurrence incidence was 66% (59–73%), 63% (48–82%), 66% (57–76%), and 77% (66–90%), respectively. The 6-year distant metastasis incidence was 13% (9–19%), 3% (0.4–22%), 5% (2–11%), and 4% (1–16%), respectively. On multivariable analysis, DD → WD was associated with improved overall survival when compared with DD → DD (p < 0.001). Moreover, WD → DD was associated with a higher risk of LR (p = 0.025)


A change in RLPS differentiation from primary tumor to first local recurrence appears to impact survival. These findings may be useful in counseling patients on their prognosis and subsequent management.

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Correspondence to Carolyn Nessim.

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P.R.: honoraria for lectures and Advisory Boards from Novartis, BMS, MSD, Pierre Fabre, Sanfoi, Merck, Pfizer, and Blueprint Medicines. N.A.: consultant for Cepheid; grant funding from Van Andel Research Institute – Stand Up To Cancer Epigenetics Dream Team. Stand Up To Cancer is a program of the Entertainment Industry Foundation, administered by AACR; she is a member of the Scientific Advisory Council to the No Stomach for Cancer Foundation, and sits on the Yale New Haven Hospital Board of Trustees; licensed methylation biomarkers to Cepheid (Patent No. 10167513); shares in Coca-Cola and IBM; her spouse is an IBM employee, and owns a private technology company. G.G.; grants from: Bayer, Pharmamar, Novartis. Personal fees: Novartis, Bayer, Pharmamar, Lilly, EISAI, Merck, and Tesaro. This paper was accepted as an Oral Presentation at the Society of Surgical Oncology Annual Cancer Symposium, Virtual August 17–18, 2020 and voted amongst the Best of SSO 2020.

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The original online version of this article was revised: Elisabetta Pennacchioli’s affiliation was corrected.

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Nessim, C., Raut, C.P., Callegaro, D. et al. Analysis of Differentiation Changes and Outcomes at Time of First Recurrence of Retroperitoneal Liposarcoma by Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Surg Oncol 28, 7854–7863 (2021).

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