腹膜后去分化脂肪肉瘤的CT表现及术后一年内复发的预后分析

Computed tomography manifestations of retroperitoneal dedifferentiated liposarcoma and the correlation with imaging classification and prognosis

目的:探讨腹膜后去分化脂肪肉瘤(DDL)的CT影像分型及其术后1年内的复发情况,初步探索二者间可能存在的联系。方法:选取2010年11月-2020年12月经手术病理证实的腹膜后去分化脂肪肉瘤病例31例,回顾性分析其CT影像表现及其术后一年内的复发情况,探究肿瘤术后1年内的预后影响因素并评估基于CT影像表现的分型在提示肿瘤术后复发方面的应用价值。结果:①年龄、性别、肿瘤瘤体长径、肿块是否多灶、肿瘤类型(原发/继发)等指标均与腹膜后DDL术后1年内复发情况无关(P>0.05)。CT上肿瘤脂肪成分占比、肿瘤内是否有偏囊性低密度区、肿瘤内不同密度成分相互移行是否模糊等指标为腹膜后DDL术后1年内复发的危险因素(P<0.05)。②Kaplan-Meier法单因素生存分析结果显示:影像分型Ⅰ型组(10.583月)患者肿瘤术后1年内平均复发间隔时间长于Ⅲ型组(7.616月),差异有统计学意义(P=0.021),而Ⅱ型与Ⅰ型、Ⅱ型与Ⅲ型之间呈现出的平均复发间隔时间之间的差异均无统计学差异(P值分别为0.423、0.417)。结论:腹膜后去分化脂肪肉瘤因肿瘤组织成分及分布不同其CT影像表现形式多种多样,成熟脂肪成分越少或实性成分越混杂(内伴或不伴有脂肪成分)的肿瘤术后1年内复发率更高,基于CT影像表现的分型在对DDL的术前诊断、术后随访及预后提示等方面具有一定的指导意义。

Objective:To investigate the CT imaging classification of retroperitoneal dedifferentiated liposarcoma(DDL)and its recurrence within one year after surgery,and to initially explore the possible relationship between the imaging classification and recurrence of DDL.Methods:We Selected 31 cases of patients with retroperitoneal dedifferentiated liposarcoma who were confirmed by surgery and pathology in our hospital from November 2010 to December 2020.Their CT feature and recurrence within one year after surgery were retrospectively analyzed.The prognostic factors within one year after tumor surgery were explored.Results:The results were that:①Age,gender,tumor body length,whether the tumor is multifocal,tumor type(primary or secondary),and other indicators do not affect the recurrence of retroperitoneal DDL within one year after surgery(P>0.05).The proportion of fat components in tumors on CT,whether there is a cystic low-density area in tumors on CT,and whether the migration of different density components in tumors on CT is vague are risk factors for recurrence within one year after surgery(P<0.05).②The average recurrence interval of patients in the imaging typeⅠgroup(10.583 months)was longer than that in the typeⅢgroup(7.616 months)and the difference was statistically significant(P=0.021),but there is no statistically significant difference between typeⅡand typeⅠ,typeⅡand typeⅢ(P=0.423 and 0.417,respectively).Conclusion:Retroperitoneal dedifferentiated liposarcoma has a variety of CT imaging manifestations due to different tumor tissue composition and distribution.The less mature fat component or the more mixed solid components(with or without fat components),the tumor recurrence rate within one year after surgery is higher,and classification based on CT imaging is of great significance in the preoperative diagnosis of DDL,postoperative follow-up,and prognosis.