【摘要】 目的:探讨腹膜后脂肪肉瘤(retroperitoneal liposarcoma)患者的临床病理学特征与预后的关系,寻找影响预后的独立临床病理指标。方法:收集本院2008年1月至2018年1月行手术治疗的腹膜后脂肪肉瘤病理标本,研究组织病理学特征包括肿瘤大小、组织学类型、淋巴结转移、脉管瘤栓、神经侵犯等,免疫组织化学特征包括Ki-67、P53蛋白表达,分子病理特征包括MDM2基因扩增;分析临床治疗及随访信息,采用Kaplan-Meier法计算患者生存率;以生存预后模型进行单因素和多因素分析,分析影响预后的独立临床病理学因素。结果:共纳入114例腹膜后脂肪肉瘤,男59例(51.8%),女55例(48.2%),中位年龄52(22～80)岁。高分化脂肪肉瘤48例(42.1%),去分化脂肪肉瘤66例(57.9%);淋巴结有转移者2例(1.4%);有脉管瘤栓者3例(2.6%);Ki-67阳性指数<60%者88例(77.2%),≥60%者26例(22.8%);P53<70%者85例(74.6%),≥70%者29例(25.4%),荧光原位杂交发现MDM2基因扩增。单因素分析发现影响患者生存的临床病理指标包括:组织病理学类型、FNCLLC分级、复发、坏死、核分裂像、P53阳性百分比、Ki-67阳性指数。多因素分析显示坏死(HR=1.984,P=0.024)、复发(HR=2.161,P=0.049)为独立预后因子。结论:肿瘤坏死、复发可能是腹膜后脂肪肉瘤的临床病理独立预后指标。更多还原

【Abstract】 Objective: To investigate the correlations between clinicopathological characteristics and prognosis for retroperitoneal liposarcoma to identify independent pathological indicators that affect prognosis. Methods: Pathological specimens from patients with retroperitoneal liposarcoma who underwent surgery at Beijing Shijitan Hospital, Capital Medical University from January 2008 to January 2018 were collected to examine histopathological features, including tumor size, histological types, lymphatic metastasis, vascular tumor emboli, and nerve invasion; immunohistochemical features, including Ki-67 and P53 proteins; and molecular pathological features such as MDM2 gene amplification. Clinical treatment and follow-up data were collected, and the survival rate was calculated using the Kaplan-Meier method.Univariate and multivariate survival analyses were performed to identify independent pathological factors. Results: Among 114 patients with retroperitoneal liposarcoma, 59 were males(51.8%) and 55 were females(48.2%), with a median age of 52(range, 22-80) years. Fortyeight(42.1%) patients had well-differentiated liposarcoma and 66(57.9%) had de-differentiated liposarcoma, with 2(1.4%) patients having lymph node metastases and 3(2.6%) having tumor emboli in the vessels. Eighty-eight(77.2%) patients had Ki-67 label index <60% and 26(22.8%) had Ki-67 label index ≥60%; furthermore, 85(74.6%) patients had P53 <70% and 29(25.4%) had P53≥70%. Fluorescent in situ hybridization(FISH) study revealed MDM2 gene amplification. Univariate analysis revealed that the following pathological factors were correlated with prognosis: histopathological classification, FNCLLC grading, recurrence, mitosis, tumor necrosis, Ki-67 label index, and P53-positive ratio. Multivariate analysis using the Cox proportional hazard model revealed the following two independent pathological prognostic factors: tumor necrosis(HR=1.984, P=0.024) and recurrence(HR=2.161,P=0.049). Conclusions: Tumor necrosis and recurrence are independent pathological prognostic factors for retroperitoneal liposarcoma.更多还原