Diagnosis And Treatment Of Primary Retroperitoneal Leiomyosarcoma In 41 Cases

Objective:To summarize the clinical characteristics,diagnosis and treatment of primary retroperitoneal leiomyosarcoma and explore the relevant factors of prognosis of primary retroperitoneal leiomyosarcoma.Methods:The clinical data and follow-up data of patients with primary retroperitoneal leiomyosarcoma admitted from January 2006 to December 2017 at the Affiliated Hospital of Qingdao University were retrospectively analyzed.A total of 41 patients met the criteria,including 9 male cases(21.9%),32 cases(78.1%)of female cases;age 28-75years old,median age 59 years;83%of patients had no specific clinical symptoms before admission;35 cases(85.4%)of radical resection tumors,including extended resection 24cases(68.6%)mainly invaded the inferior vena cava,kidney and kidney vessels;the median operation time was 180 minutes;the median diameter of the tumor was 10 cm;7patients received adjuvant chemotherapy.The statistical analysis was made on the factors that may affect the postoperative survival and progression-free survival of patients with primary retroperitoneal leiomyosarcoma.Results:In The overall median survival time was 38 months.The overall survival rates at 1 year、3 years、and 5 years after operation were 87.6%、53.8%and 40.1%.Among the factors that may affect postoperative survival time,the maximum tumor size(c~2=6.919,P=0.009),tumor differentiation(c~2=15.055,P=0.000),whether radical surgery(c~2=7.090,P=0.008),intraoperative blood loss(c~2=9.729,P=0.002)is an important factor affecting the overall survival of primary retroperitoneal leiomyosarcoma surgery(P<0.05),while age(c~2=0.562,P=0.454),adjuvant therapy(c~2=0.143,P=0.705),Sex(c~2=0.942,P=0.332),Surgical time(c~2=2.280,P=0.131)had no effect on the overall survival of patients(P>0.05);multivariate analysis showed tumor differentiation(P=0.001,RR=5.591),intraoperative blood loss(P=0.021,RR=3.873),and radical surgery(P=0.002,RR=6.210)are the overall survival effects of patients with primary retroperitoneal leiomyosarcoma Independent risk factors.The median progression-free survival of patients with primary retroperitoneal leiomyosarcoma was 33 months.The postoperative 1-year,3-year,and 5-year progression-free survival rates were 82.9%、46.2%and 32.9%,respectively;Among the influencing factors of progressive survival,intraoperative blood loss(c~2=4.493,P=0.034),whether radical surgery(c~2=6.690,P=0.010),tumor differentiation(c~2=12.038,P=0.001)is an important influence factor(P<0.05).Multivariate analysis showed that the amount of hemorrhage(P=0.115)was not an independent risk factor affecting the disease-free survival rate;the degree of tumor differentiation(P=0.001,RR=5.175)and radical surgery(P=0.005,RR=4.978).)is an independent risk factor for progression-free survival in patients with primary retroperitoneal leiomyosarcoma.Conclusions:There are no specific symptoms in the early stage of primary retroperitoneal leiomyosarcoma.Surgical treatment is the main treatment method for primary retroperitoneal leiomyosarcoma;the effect of adjuvant therapy such as chemoradiation is still not clear.The maximum diameter of the tumor,the amount of intraoperative blood loss,the degree of tumor differentiation,and whether it is a radical operation are the effects of primary retroperitoneal smooth muscle.The important influencing factors of tumor prognosis;the degree of tumor differentiation and radical surgery are independent risk factors for the postoperative progression-free survival of patients with primary retroperitoneal leiomyosarcoma.