Prognostic impact of total (Ipsilateral) retroperitoneal lipectomy vs. complete resection in retroperitoneal liposarcoma: A retrospective cohort study with nomogram

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BACKGROUND: Retroperitoneal liposarcoma (RPLS), the most common retroperitoneal sarcoma, poses significant therapeutic challenges due to high recurrence rates. This study evaluates the long-term outcomes of total (Ipsilateral) retroperitoneal lipectomy (TRL) versus complete resection (CR) and develops prognostic nomograms. METHODS: A retrospective analysis was conducted on 208 RPLS patients who underwent surgical treatment at the Department of Retroperitoneal Tumor Surgery, Affiliated Hospital of Qingdao University, between January 2015 and December 2022. Patients were stratified into the Complete Resection (CR) group (n = 152) and the TRL group (n = 56). Kaplan-Meier analysis and log-rank tests were used to compare overall survival (OS) and recurrence-free survival (RFS). Patients were randomly divided into training (70 %) and validation (30 %) cohorts. Univariate and multivariate Cox regression analyses identified independent prognostic factors, which were incorporated into nomograms. Model performance was assessed using the area under the curve (AUC), concordance index (C-index), calibration curves, and decision curve analysis (DCA). RESULTS: Among 208 included patients, the TRL group demonstrated significantly higher OS and RFS rates compared to the CR group. Surgical approach, subtype, and types of tumor occurrence were independent predictors of OS. Surgical approach, subtype, and duration significantly influenced RFS. CONCLUSION: TRL may improve long-term survival outcomes in RPLS patients and could serve as a potential independent protective prognostic factor, though this requires validation through multicenter external studies. The developed nomograms for OS and RFS show promising predictive performance and potential clinical application value, but their generalizability needs to be further confirmed by external validation.

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