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Abstract：
Retroperitoneal sarcomas (RPS) are rare tumours of mesenchymal origin, commonly presented as a large tumour mass at time of diagnosis. We investigated the impact of body composition on outcome in patients operated on for primary localized RPS.
We retrospectively analysed data for all patients operated on for primary RPS at our institution between 1999 and 2020. Preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT) and muscle radiation attenuation (MRA) were calculated using computed tomography scans at the level of third lumbar vertebra. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were applied to define myopenia. Using maximum log-rank statistic method we determined the optimal cut-off values of body composition parameters. Myosteatosis was defined based on determined MRA cut-offs.
In total 58 patient were eligible for the study. With a median follow-up of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) were 66.8% and 77.6%, respectively. Patients with myopenia had significantly lower 5-year OS compared to non-myopenic (p = 0.009). Skeletal muscle index and subcutaneous adipose tissue index predicted LRFS on univariate analysis (p = 0.052 and p = 0.039, respectively). In multivariate analysis high visceral-to-subcutaneous adipose tissue area ratio (VSR) independently predicted higher postoperative complication rate (89.2% vs. 10.8%, p = 0.008). Myosteatosis was associated with higher postoperative morbidity.
Myopenia affected survival, but not postoperative outcome in RPS. Visceral obesity, VSR (> 0.26) and myosteatosis were associated with higher postoperative morbidity. VSR was better prognostic factor than VAT in RPS.
We retrospectively analysed data for all patients operated on for primary RPS at our institution between 1999 and 2020. Preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT) and muscle radiation attenuation (MRA) were calculated using computed tomography scans at the level of third lumbar vertebra. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were applied to define myopenia. Using maximum log-rank statistic method we determined the optimal cut-off values of body composition parameters. Myosteatosis was defined based on determined MRA cut-offs.
In total 58 patient were eligible for the study. With a median follow-up of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) were 66.8% and 77.6%, respectively. Patients with myopenia had significantly lower 5-year OS compared to non-myopenic (p = 0.009). Skeletal muscle index and subcutaneous adipose tissue index predicted LRFS on univariate analysis (p = 0.052 and p = 0.039, respectively). In multivariate analysis high visceral-to-subcutaneous adipose tissue area ratio (VSR) independently predicted higher postoperative complication rate (89.2% vs. 10.8%, p = 0.008). Myosteatosis was associated with higher postoperative morbidity.
Myopenia affected survival, but not postoperative outcome in RPS. Visceral obesity, VSR (> 0.26) and myosteatosis were associated with higher postoperative morbidity. VSR was better prognostic factor than VAT in RPS.
摘要：
背景：腹膜后肉瘤（RPS）是间充质起源的罕见肿瘤，通常在诊断时表现为巨大的肿瘤块。我们调查了身体成分对原发性局部RPS手术患者预后的影响。
方法：我们回顾性分析了1999年至2020年间在我们机构接受原发性RPS手术的所有患者的数据。术前骨骼肌面积(SMA),使用计算机断层扫描在第三腰椎水平计算内脏和皮下脂肪组织面积（VAT和SAT）和肌肉辐射衰减（MRA）。应用欧洲老年人肌肉减少症工作组（EWGSOP2）标准来定义肌肉减少症。使用最大对数秩统计方法，我们确定了身体成分参数的最佳截止值。基于确定的MRA截止值定义肌骨形成。
结果：共有58名患者符合研究条件。中位随访时间为116个月，估计的5年总生存率（OS）和无局部复发生存率（LRFS）分别为66.8％和77.6％，分别。与非肌肉减少症患者相比，肌肉减少症患者的5年OS显着降低（p=0.009）。骨骼肌指数和皮下脂肪组织指数预测单变量分析的LRFS(分别为p=0.052和p=0.039)。在多变量分析中，高内脏与皮下脂肪组织面积比（VSR）独立预测术后并发症发生率较高（89.2％vs.10.8%,p=0.008)。肌肉骨化与较高的术后发病率相关。
结论：肌减少症影响生存率，但不是RPS的术后结果。内脏肥胖，VSR（>0.26）和肌骨形成与较高的术后发病率相关。在RPS中，VSR比VAT是更好的预后因子。
方法：我们回顾性分析了1999年至2020年间在我们机构接受原发性RPS手术的所有患者的数据。术前骨骼肌面积(SMA),使用计算机断层扫描在第三腰椎水平计算内脏和皮下脂肪组织面积（VAT和SAT）和肌肉辐射衰减（MRA）。应用欧洲老年人肌肉减少症工作组（EWGSOP2）标准来定义肌肉减少症。使用最大对数秩统计方法，我们确定了身体成分参数的最佳截止值。基于确定的MRA截止值定义肌骨形成。
结果：共有58名患者符合研究条件。中位随访时间为116个月，估计的5年总生存率（OS）和无局部复发生存率（LRFS）分别为66.8％和77.6％，分别。与非肌肉减少症患者相比，肌肉减少症患者的5年OS显着降低（p=0.009）。骨骼肌指数和皮下脂肪组织指数预测单变量分析的LRFS(分别为p=0.052和p=0.039)。在多变量分析中，高内脏与皮下脂肪组织面积比（VSR）独立预测术后并发症发生率较高（89.2％vs.10.8%,p=0.008)。肌肉骨化与较高的术后发病率相关。
结论：肌减少症影响生存率，但不是RPS的术后结果。内脏肥胖，VSR（>0.26）和肌骨形成与较高的术后发病率相关。在RPS中，VSR比VAT是更好的预后因子。
