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Original article
Prognosis and survival of patients diagnosed with well-differentiated and dedifferentiated retroperitoneal liposarcoma
Pronóstico y supervivencia de pacientes diagnosticados de liposarcoma retroperitoneal bien diferenciado y desdiferenciado
Julio Osuna-Sotoa,, Teresa Caro Cuencab,, Alicia Sanz-Zorrillab, Antonio Torrecilla-Martíneza, Rosa Ortega Salasb, Fernando Leiva-Cepasa,b,c,
Corresponding author
a Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
c Grupo de Investigación en Regeneración Muscular (REGMUS), Universidad de Córdoba, Córdoba, Spain
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the first two being the most frequently found in the retroperitoneum &#40;90&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Due to their location&#44; retroperitoneal liposarcomas &#40;RPLS&#41; are usually diagnosed late&#44; when they have already reached a large size and invaded numerous adjacent visceral structures&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The rate of distant metastasis&#44; even for high-grade ones&#44; is relatively low &#40;10&#8211;15&#37;&#41;&#44; so the mortality of RPLS is more related to its local aggressiveness&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">On this basis&#44; it has been stated that the most important prognostic factor in RPLS is complete surgical resection&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> with chemotherapy and&#47;or radiotherapy playing a role depending on the type of surgery&#44; recurrence or size of the specimen&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Complete tumour excision is not straightforward and&#44; in many cases&#44; free margins cannot be achieved&#46; This explains the high recurrence rate and morbidity and mortality associated with wide&#44; multivisceral surgical resections in this type of tumour&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However&#44; even with wide resections&#44; it appears that the course of the disease differs according to the histological subtype of the RPLS&#44; being more benign in well-differentiated RPLS &#40;WDRPLS&#41; than in dedifferentiated RPLS &#40;DDRPLS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> Therefore&#44; it could be suggested that the former&#44; due to their low malignancy potential&#44; could be managed more conservatively&#44; avoiding extensive and mutilating resections and reducing morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> However&#44; a lax follow-up of the patient may imply a high risk of recurrence&#44; with the consequent added morbidity and mortality&#44; which is why there are contradictory results according to published studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5&#44;10&#44;18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Furthermore&#44; there is a not inconsiderable percentage of reoperation due to an increase in histological grade when analysing the complete surgical specimen&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;20&#44;21</span></a> This makes it difficult to establish an adequate diagnostic-therapeutic and prognostic protocol for these patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus&#44; based on the hypothesis that patients with WDRPLS have a better prognosis than those with DDRPLS&#44; the main objectives of this study are to determine overall survival and disease-free survival in patients with retroperitoneal sarcoma&#44; distinguishing between the two histopathological entities and comparing them with each other&#44; as well as analysing the clinical characteristics of the patients in the cohort and identifying other independent variables that may influence their prognosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We designed an observational and analytical study using a retrospective historical cohort that is followed prospectively&#46; This cohort is composed of 32 patients who underwent surgery for primary RPLS of well-differentiated and dedifferentiated histological subtypes at our centre between January 2002 and May 2019&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All variables were obtained retrospectively from clinical&#44; radiological&#44; surgical&#44; oncological&#44; anatomopathological reports collected from the patients&#39; clinical records&#44; with the formal authorisation of the responsible Biomedical Research Ethics Committee&#44; adopting at all times the due considerations&#44; conditions indicated by this body&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The qualitative variables considered for the analyses were&#58; sex &#40;male&#47;female&#41;&#44; occurrence of recurrence during the study &#40;yes&#47;no&#41;&#44; vital status &#40;alive&#47;dead&#41;&#44; medical history of another malignancy &#40;yes&#47;no&#41;&#44; involvement of surgical edges of the primary tumour &#40;R0&#44; free&#47;R1&#44; affected&#41;&#44; early recurrence &#40;occurrence of recurrence less than 2 years after removal of the primary tumour&#59; yes&#47;no&#41;&#44; presence of metastases &#40;no&#47;ganglionic&#47;distant&#41;&#44; visceral resection in the intervention of the primary tumour &#40;simple lumpectomy&#47;nephrectomy&#47;multivisceral with involvement of two or more organs&#41; and treatment of the primary tumour &#40;surgery&#47;surgery plus adjuvant chemotherapy&#47;surgery plus adjuvant radiotherapy&#41;&#46; Quantitative variables were&#58; age at diagnosis &#40;years&#41;&#44; age at death &#40;years&#41;&#44; number of recurrences&#44; tumour size &#40;maximum diameter of the primary tumour in cm&#41;&#44; overall survival &#40;years&#41; and disease-free survival &#40;years&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">For the comparison of proportions between qualitative variables&#44; contingency tables and the Chi-square test were used&#44; or&#44; failing that&#44; Fisher&#39;s exact test when the sample size did not allow the former to be applied&#46; For the comparison of means of quantitative variables&#44; Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used&#44; after checking for normal distribution using Saphiro&#8211;Wilk&#59; in cases where it could not be applied&#44; non-parametric tests were used&#44; specifically the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test</p><p id="par0040" class="elsevierStylePara elsevierViewall">For the analysis of overall survival and disease-free period&#44; Kaplan&#8211;Meier estimates were used to summarise and represent survival functions and the log-rank test for comparative analysis&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In all cases the hypothesis testing was bilateral and a p-value &#60; &#46;05 was considered statistically significant&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">IBM&#174; SPSS Statistics 25 was used for all statistical calculations and estimations in the study&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Histologically&#44; WDRPLS &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; is a lipogenic neoplasm of intermediate malignancy consisting of atypical adipocytes &#40;with variability in size&#44; shape and with hyperchromatic nuclei&#41; and atypical stromal cells&#46; In contrast&#44; DDRPLS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; is a malignant lipogenic neoplasm&#44; in which there is an abrupt transition between atypical lipogenic cells and non-lipogenic sarcomatous cells with wide variation in the lipogenic component&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The descriptive data of the sample are shown in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46; When compared according to histological subtype&#44; the variables generally maintain a homogeneous distribution&#46; However&#44; it is noteworthy that tumour size was larger in the dedifferentiated type&#44; and this difference was statistically significant&#46; In relation to this&#44; it can be seen that tumours of this histological type required more aggressive interventions&#44; especially in terms of nephrectomy&#44; although no significant differences were found&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Although they have been presented in the descriptive study&#44; the variables marked with an asterisk &#40;&#42;&#41; depend on the time factor for development&#44; which is not homogeneous for all patients&#44; so they cannot be analysed using the previous statistics and survival studies will be used for this purpose&#46; It can be intuited&#44; however&#44; that patients with a dedifferentiated phenotype presented a higher percentage of relapses&#44; which were also earlier and more numerous&#44; although these data should be analysed with caution due to the aforementioned bias&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding survival studies&#44; the estimated media overall survival was 10&#46;8 years &#40;95&#37;CI&#58; 7&#46;9&#8211;13&#46;6&#41;&#44; with a 5-year survival of approximately 59&#37;&#46; Patients diagnosed with WDRPLS had a median estimated survival of 11&#46;2 years &#40;95&#37;CI&#58; 6&#46;7&#8211;15&#46;7&#41;&#44; while in the dedifferentiated subtype the median was 9&#46;3 years &#40;95&#37;CI&#58; 6&#46;4&#8211;12&#46;2&#41;&#46; As can be seen in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44; both survival curves are similar&#44; with no significant differences found in the comparison using the log-rank test &#40;p &#61; &#46;834&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Furthermore&#44; with regard to disease-free survival&#44; overall the estimated media was 4&#46;7 years &#40;95&#37;CI&#58; 2&#46;9&#8211;6&#46;5&#41;&#46; However&#44; the distribution according to histological type is very different&#58; in WDRPLS the mean disease-free survival was 7&#46;6 years &#40;95&#37;CI&#58; 4&#46;6&#8211;10&#46;7&#41;&#44; while in DDRPLS the mean was only 2&#46;1 years &#40;95&#37;CI&#58; 1&#46;6&#8211;2&#46;6&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In this case&#44; it can be seen &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; that the survival curves differ overall in their morphology&#44; and these differences are statistically significant according to the log-rank test &#40;p &#61; &#46;005&#41;&#46; In patients with dedifferentiated tumours&#44; in no case did they exceed 4 years of follow-up without recurrence&#59; in fact&#44; only 3 patients in this group completed the study without recurrence&#46; In contrast&#44; of the group of patients with well-differentiated tumours&#44; only one patient had a late recurrence beyond 2 years of follow-up &#40;at 8 years&#41;&#46; This means that disease-free survival at 2 years is 59&#37; in well-differentiated tumours&#44; while in dedifferentiated tumours it is only approximately 26&#37;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">With respect to the other variables studied&#44; none of them seem to significantly influence overall survival or disease-free survival&#46; Survival analysis of the variables &#34;metastasis&#34; and &#34;medical history of other malignant processes&#34; was not performed due to the small number of cases&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">From a sociodemographic point of view&#44; our cohort has a median age similar to other published groups&#44; but with a slightly higher prevalence of women&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Furthermore&#44; the presence of previous malignant pathology was only evident in 4 patients&#44; with no association between the type of previous tumour and the development of RPLS&#46; Although the appearance of sarcomas is described as a complication of radiotherapy&#44; liposarcoma is exceptional in these cases&#44; with other cell lines predominating in locations other than the retroperitoneum&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Histopathologically&#44; DDRPLS was the most frequent&#44; which contrasts with other groups&#44; mainly English-speaking ones&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> and is more consistent with the Spanish series&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;11</span></a> Likewise&#44; our data are consistent with a higher recurrence rate and lend statistical power to the assertion that worse differentiated histological subtypes confer a poorer prognosis&#44; since no patient in the DDRPLS group survived 4 years of study without recurrence&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">On the other hand&#44; in four of the cases studied there were very early recurrences of the disease&#44; with histological types that had progressed in degree of malignancy and evolved in histological type&#44; and which required subsequent molecular confirmation of the diagnosis made with routine stains&#46; Currently&#44; molecular pathology techniques are an essential tool in the management of these cases<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;23</span></a>&#44; and other published work by Gronchi&#8217;s group<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> already suggests the need for molecular typing of primary tumours with unfavourable evolution&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Several groups have studied the effect of early recurrence and have related it to lower overall survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;9</span></a> However&#44; this could not be demonstrated in our study&#59; although overall survival at 5 years was 53&#37; in the early recurrence group &#40;less than 2 years&#41; compared to 75&#37; in the non-recurrent group&#44; these differences were not statistically significant&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Given that RPLSs are tumours that may be large in size&#44; surgical intent involves extensive visceral resections to obtain wide tumour-free surgical margins&#44; as this is one of the best prognostic factors in all published series as it increases disease-free survival&#46; enfermedad<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;25</span></a> In this regard&#44; 25&#37; of the patients included in this study required multivisceral resection&#44; and only 19&#37; underwent simple excision of the tumour without resection of any organ&#44; of which only one was of dedifferentiated lineage&#46; Although these data are interesting&#44; and there is consensus that adequate surgery in a specialised centre is the most effective treatment&#44; there is no defined tumour extension to be removed to guarantee R0&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20&#44;26</span></a> In our experimental development&#44; patients with extensive tumour resections that included kidney or more viscera did not imply statistically significant improvements in survival studies&#46; However&#44; these results should be handled with caution&#44; as more aggressive resections were performed to a greater extent in histologically unfavourable tumours&#46; Also&#44; complications from renal resection should be taken into consideration&#58; 2 of our patients developed end-stage renal failure&#44; although we have not found studies evaluating this in other cohorts&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In addition to these data&#44; microscopic study of the surgical margins revealed tumour involvement in 50&#37; of cases&#44; with the same percentage of 50&#37; between well-differentiated and dedifferentiated tumours&#46; Gronchi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and Chouliaras et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> have shown that free surgical margins are associated with a better prognosis&#46; However&#44; in our study survival estimates show no significant difference between the two curves&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Although there are disparities in the published studies&#44; it seems that radiotherapeutic treatment may be more positive than chemotherapy&#44; as has been shown in studies with large sample sizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> In our study&#44; few patients were treated with radiotherapy or adjuvant chemotherapy in the treatment of the primary tumour &#40;4 and 5 patients&#44; respectively&#41;&#44; with adjuvant therapy being reserved for recurrences in most cases&#46; Furthermore&#44; the decision to apply adjuvant therapy was due to tumours that were difficult to resect and with extensive involvement of the surgical margins&#44; in which the results of surgery were not satisfactory&#46; Therefore&#44; with these data&#44; it is not possible to extrapolate conclusions in this regard&#44; and larger&#44; more adequately designed&#44; targeted trials are needed&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Among the limitations of our study is that the sample size was not very large&#44; which implies a limitation when applying statistical tests to demonstrate significant differences &#40;increased type II error&#41;&#46; In addition&#44; retrospective review has a natural tendency to bias&#46; These facts prevent us from establishing certain firm conclusions that can be extrapolated with respect to prognostic and survival factors&#44; so the results should always be taken with caution and as an approximation&#44; and should be checked with other studies with more appropriate methodology&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In short&#44; the only factor studied that significantly modified the prognosis of these patients was the histological subtype of the tumour&#46; This is why we propose that the histopathological factors intrinsic to the tumour are fundamental and largely condition the results of surgery with curative intent&#46; As a result&#44; proper histological diagnosis is of vital importance in the therapeutic management of these patients&#46; However&#44; more studies are needed to unify criteria in the diagnostic and therapeutic management of these tumours in order to increase survival and reduce morbidity and mortality in these patients&#44; because&#44; for the time being&#44; liposarcomas generally continue to have a poor prognosis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">This research has not received specific support from public sector agencies&#44; commercial or not-for-profit organisations&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The main objective is to establish the overall survival and disease-free survival profiles regarding the patients with retroperitoneal liposarcoma&#44; making a comparison based on the well-differentiated and dedifferentiated histological subtypes&#46; The secondary objectives are to descriptively analyze the clinical characteristics of said patients and to identify and analyze other independent variables that might modify these survival profiles significantly&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An observational and analytical study was performed using a retrospective historical cohort that was followed prospectively&#46; The inclusion criteria consisted of&#58; the procedure of liposarcoma located in the retroperitoneum&#44; the well-differentiated and dedifferentiated histological subtypes&#44; between January of 2002 and May of 2019&#46; As a result&#44; 32 patients took part in this study&#8217;s sample&#46; Kaplan&#8211;Meier estimator was used to summarise the results and log-rank test was used in the comparative analysis&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The overall survival at 5 years was around 59&#37;&#46; No differences were found between the patients with a well-differentiated subtype compared to the dedifferentiated ones &#40;p&#8201;&#61;&#8201;0&#46;834&#41;&#46; The disease-free survival at 2 years was 59&#37; regarding the well-differentiated and 26&#37; regarding the dedifferentiated&#44; with these differences being statistically significant &#40;p&#8201;&#61;&#8201;0&#46;005&#41;&#46; None of the other studied variables modified these survival profiles significantly&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Dedifferentiated retroperitoneal liposarcomas show less disease-free survival than well-differentiated liposarcomas&#46; However&#44; regarding overall survival no differences can be claimed&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">El objetivo principal es determinar la supervivencia global y la supervivencia libre de enfermedad de pacientes intervenidos de liposarcoma retroperitoneal&#44; compar&#225;ndolos en funci&#243;n de los subtipos histol&#243;gicos bien diferenciado y desdiferenciado&#46; Los objetivos secundarios son analizar descriptivamente las caracter&#237;sticas cl&#237;nicas de estos pacientes e identificar otras variables independientes que puedan modificar significativamente estos perfiles de supervivencia&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se realiza un estudio observacional y anal&#237;tico mediante una cohorte hist&#243;rica retrospectiva&#44; seguida prospectivamente&#46; Los criterios de inclusi&#243;n fueron&#58; cirug&#237;a de liposarcoma de localizaci&#243;n retroperitoneal&#44; subtipo histol&#243;gico bien diferenciado y desdiferenciado&#44; entre enero de 2002 y mayo de 2019&#46; Se incluyeron un total de 32 pacientes&#46; Se utiliz&#243; el estimador de Kaplan-Meier para resumir los datos y la prueba log-rank para el an&#225;lisis comparativo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">La supervivencia global a los 5 a&#241;os fue del 59&#37;&#46; No se encontraron diferencias entre los pacientes con subtipo bien diferenciado con respecto al desdiferenciado &#40;p&#8201;&#61;&#8201;0&#44;834&#41;&#46; La supervivencia libre de enfermedad a los 2 a&#241;os fue del 59&#37; en los bien diferenciados y del 26&#37; en los desdiferenciados&#44; siendo estas diferencias estad&#237;sticamente significativas &#40;p&#8201;&#61;&#8201;0&#44;005&#41;&#46; Ninguna de las otras variables estudiadas modific&#243; significativamente estos perfiles de supervivencia&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La supervivencia libre de enfermedad de los liposarcomas retroperitoneales desdiferenciados es significativamente menor que en los bien diferenciados&#44; pero no puede afirmarse que haya diferencias en la supervivencia global&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0030"
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          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusiones"
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        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:3 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">These authors contributed equally to this paper&#46;</p>"
        "identificador" => "fn0005"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Osuna-Soto J&#44; Caro Cuenca T&#44; Sanz-Zorrilla A&#44; Torrecilla-Mart&#237;nez A&#44; Ortega Salas R&#44; Leiva-Cepas F&#46; Pron&#243;stico y supervivencia de pacientes diagnosticados de liposarcoma retroperitoneal bien diferenciado y desdiferenciado&#46; Cir Esp&#46; 2022&#59;100&#58;622&#8211;628&#46;</p>"
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      0 => array:8 [
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        "etiqueta" => "Figure 1"
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        "figura" => array:1 [
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Well-differentiated liposarcoma H-E 100&#215;&#46; Mature adipocytes with significant variations in size and fibrous tracts with atypical stromal cells&#46; Inset&#58; atypical stromal cell at higher magnification &#40;400&#215;&#41;&#46;</p>"
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      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#46; Dedifferentiated liposarcoma H-E 100&#215;&#46; Abrupt transition from well-differentiated liposarcoma &#40;black asterisk&#41; to high-grade non-lipogenic sarcoma &#40;white asterisk&#41;&#46; B&#46; Undifferentiated liposarcoma H-E 200&#215;&#46; High-grade sarcoma with pleomorphic cells and atypical mitoses &#40;white arrow&#41;&#46;</p>"
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      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estimated overall survival according to anatomopathological diagnosis&#46; BD&#58; well-differentiated &#40;blue&#41;&#59; DD&#58; dedifferentiated &#40;red&#41;&#46;</p>"
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      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Estimated disease-free survival according to pathological diagnosis&#46; BD&#58; well-differentiated&#59; DD&#58; dedifferentiated&#46;</p>"
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      4 => array:8 [
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">WD&#58; well differentiated&#59; dd&#58; de-differentiated&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Statistically significant outcomes are in bold&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total 32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">WD 14 &#40;43&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DD 18 &#40;56&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at diagnosis &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;50 &#40;50&#44;3&#8211;67&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;48&#46;8&#8211;68&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;50&#46;8&#8211;66&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#8201;&#61;&#8201;&#46;864&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Size &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;50 &#40;18&#46;6&#8211;31&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;50 &#40;15&#46;3&#8211;25&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;19&#46;7&#8211;35&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">p&#8201;&#61;&#8201;&#46;013</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at death &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;56&#8211;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;50 &#40;48&#46;5&#8211;75&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;56&#46;5&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#8201;&#61;&#8201;&#46;634&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number relapses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5 &#40;0&#8211;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#8722;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Not assessable by these statistical analyses&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Descriptive study 1&#58; quantitative variables&#46; Expressed according to median and statistical analysis according to histological diagnosis&#46; In brackets&#44; interquartile range between first and third quartiles&#46;</p>"
        ]
      ]
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">WD&#58; well differentiated&#59; DD&#58; de-differentiated&#59; QT&#58; chemotherapy&#59; Qx&#58; surgery&#59; RT&#58; radiotherapy&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total 32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DD 18 &#40;56&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Man&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;35&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#8201;&#61;&#8201;1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Woman&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;65&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;64&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgical margins</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Free &#40;R0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#8201;&#61;&#8201;1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Affected &#40;R1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">History of malignant pathology</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;7&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#8201;&#61;&#8201;&#46;613&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;87&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;92&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;83&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early relapse &#40;&#60;2 years&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;53&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;35&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#8201;&#61;&#8201;&#46;121&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visceral resection</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&#58; No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;35&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A vs&#46; B&#58; p&#8201;&#61;&#8201;&#46;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A vs&#46; C&#58; p&#8201;&#61;&#8201;&#46;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B vs&#46; C&#58; p&#8201;&#61;&#8201;1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&#58; Kidney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;56&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&#58; Multivisceral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;21&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;27&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Qx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;71&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;78&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Qx&#8201;&#43;&#8201;QT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735077
Original language: English
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