• Our key findings, which we believe are of significant interest to the readership of Cancer Treatment and Research Communications , include: • En bloc resection significantly improves oncologic outcomes: Patients undergoing en bloc resection had markedly superior 5-year DFS compared to piecemeal resection (41.1% vs. 16.1%, p=0.001) and showed a strong trend towards improved OS (p=0.051). Multivariate analysis confirmed piecemeal resection as an independent predictor of inferior DFS (HR=1.81, p=0.033). • Combined multivisceral resection is a major prognostic determinant: The need for combined multivisceral resection was independently associated with significantly worse DFS (HR=2.06, p=0.003) and OS (HR=5.12, p=0.001), highlighting the aggressive biology of tumors requiring such extensive surgery. • Histologic subtype is crucial: Dedifferentiated liposarcoma (DDLS) was the predominant subtype (66%) and independently predicted inferior DFS (HR=1.81, p=0.030) and OS (HR=2.93, p=0.022) compared to well-differentiated liposarcoma. • Limited benefit of adjuvant therapy: Neoadjuvant or adjuvant therapies did not demonstrate a significant survival benefit in this cohort, underscoring the critical role of optimized surgical management and the need for effective systemic therapies. This study aimed to identify key prognostic factors influencing disease-free survival (DFS) and overall survival (OS) in patients with primary retroperitoneal liposarcoma (PRPLS), and to evaluate the impact of surgical approach (en bloc vs. piecemeal resection) and combined multivisceral resection on oncologic outcomes. A retrospective cohort study included 153 consecutive patients with PRPLS undergoing surgery (2014-2023). Clinicopathological data, surgical details, and adjuvant therapies were analyzed. Primary endpoints were disease-free survival (DFS) and overall survival (OS), analyzed using Kaplan-Meier methods and Cox regression. Median age was 57 years, with male predominance (59.5%). Tumors were frequently large (52.3% >20 cm), multifocal (47.7%), and dedifferentiated (DDLS, 66.0%). Curative-intent resection (R0/R1) was achieved in 93.5% (143/153), mostly via open laparotomy. En bloc resection was performed in 73.2% (112/153); combined multivisceral resection was required in 52.9% (81/153). Median follow-up was 42 months. For R0/R1 patients (n=137), 5-year DFS was 36.5% and 5-year OS was 77.6%. Multivariate analysis identified independent predictors of inferior DFS: piecemeal resection (HR=1.81, P=0.033), combined multivisceral resection (HR=2.06, P=0.003), and DDLS histology (HR=1.81, P=0.030). Combined multivisceral resection (HR=5.12, P=0.001) and DDLS (HR=2.93, P=0.022) independently predicted worse OS. En bloc resection significantly improved 5-year DFS (41.1% vs. 16.1%, P=0.001) and showed a strong trend towards improved OS (P=0.051). Neoadjuvant/adjuvant therapy demonstrated no significant survival benefit. DDLS histology, piecemeal resection, and requirement for combined multivisceral resection are key determinants of poor prognosis in PRPLS. En bloc radical resection with negative margins (R0) should be the primary surgical goal when feasible. The role of adjuvant therapies remains uncertain and warrants prospective investigation.
Gao et al. (Sun,) studied this question.