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68 Zhuang et al. | Journal of Clinical and Translational Research 2024; 10(1): 62-71
adjusting for other confounding variables (Table 2). To determine myxoid stroma produced by tumor cells as well as promoting
the reason, we compared baseline characteristics of single and adipocyte maturation [43]. Radiotherapy can also cause a change
married patients, but there was no difference between the two in tumor size. Studies have shown that pre-operative radiotherapy
groups (data not shown). Intriguingly, when patients were divided to patients can reduce tumor seeding during surgery, but the
into four groups consisting of married men, single men, married disadvantage of pre-operative radiotherapy is that it can affect
women, and single women, the DSS of single women was wound healing [44]. Pre-operative radiotherapy may improve
significantly higher than that of the other groups. In particular, the prognosis of low-grade retroperitoneal sarcoma without
the 10-year DSS for single women, married women, single much benefit for high-grade retroperitoneal sarcoma [45]. Post-
men, and married women was 87.5 (95% CI, 75.6% – 100.0)%, operative radiotherapy can be effective in improving local control
51.3 (95% CI, 32.5% – 70.1)%, 60.5 (95% CI, 35.8% – 85.2)%, in patients with positive surgical margins, but the associated side
and 44.8 (95% CI, 28.1% – 61.5)%. Most analyses indicate that effects of post-operative radiotherapy will also increase [44].
women have better outcomes than men, but few studies indicate For soft-tissue sarcomas, tumor size is an important prognostic
that single women have better outcomes than other demographic factor and is associated with both the local recurrence rate and
groups. Based on the current data, we cannot conclude the reasons overall survival. Magnetic resonance imaging (MRI) examination
for the above differences for the time being, and further in-depth of tumor size before and after radiotherapy revealed a median
research is needed. maximum tumor size of 12.4 cm and a median tumor volume
The current study considered that an anthracycline-based of 298.9 cm . After radiotherapy, the median maximum tumor
3
combination chemotherapy regimen is the first-line treatment size on MRI was 8.7 cm, and the median tumor volume was
option and trabectedin may be considered in first-line therapy when 106.9 cm [46]. However, the role of radiotherapy in liposarcoma
3
anthracyclines cannot be used. Although doxorubicin ± ifosfamide should be explored in a prospective trial.
remains the first-line treatment for most STS subtypes, some STSs Recently, significant advances have been made in an increasing
(alveolar soft part sarcoma, clear cell sarcoma, epithelioid sarcoma, number of targeted therapies, with some targeted agents showing
and extraosseous myxoid chondrosarcoma) have been reported promising results in patients with advanced or metastatic STS.
to show little response to these cytotoxic chemotherapies [38]. Unlike other liposarcomas, the tumor microenvironment of MRCL
In addition to chemotherapy, new treatments are also being is relatively “cold” immunologically, rendering MRCL less sensitive
investigated, some of which have already shown considerable results. to immunotherapy. However, the cancer testicular antigens in these
Trabectedin is a marine-derived antitumor drug that achieves anti- tumors are highly expressed, such as NY-ESO-1 and MAGEA4.
tumor cell activity by inhibiting transcription, anti-angiogenesis, Therefore, these two antigens have become ideal targets for the
and immune regulation. Related tests show that MRCL and other treatment of MRCL patients [39]. Others such as PPARγ agonists,
translocation-related sarcomas (liposarcoma and leiomyosarcoma) PI3KCA inhibitors, and tyrosine kinase inhibitors have been shown
are the most sensitive types of sarcoma related to trabectedin [39]. to play a key role in the treatment of MRCL patients.
The French Sarcoma Group conducted a randomized phase III study This research has the following limitations: First, because it is a
evaluating the efficacy of trabectedin versus best supportive care retrospective study, there were unavoidable selection bias; second,
(BSC) in patients with advanced STS. Patients were randomized data used in this study were derived from the SEER database,
(1:1) to receive trabectedin (1.5 mg/m 24 h intravenous infusion and some information was missing; third, although 171 cases of
2
every 3 weeks) or BSC. The median PFS was 3.1 months in the MLPS/RCLPS represent the largest cohort to date, the nomogram
trabectedin group, and the median PFS was 1.5 months in the BSC prediction model established in this study had only been internally
group. It can be seen that trabectedin is better for disease control than validated, and additional external validation is required to increase
BSC [40]. Eribulin is a non-taxane microtubule inhibitor, which is the confidence of the prediction.
more sensitive to leiomyosarcomas and liposarcomas. Eribulin has
now become an effective treatment for MRCL. Several recent trials 5. Conclusion
of eribulin combined with other drugs for advanced liposarcoma
have prolonged the median PFS in patients with considerable One hundred and seventy-one patients with primary
results [39]. In a phase II trial of eribulin-gemcitabine combination retroperitoneal MLPS/RCLPS were retrospectively analyzed for
in patients with advanced liposarcoma, a 12-week PFS rate was prognostic factors using the SEER database, and the findings
70.6% (n = 12/17) in the liposarcoma cohort, with a median PFS indicate that age, marital status, previous tumor history, metastatic
of 5.7 months [41]. disease, and whether surgery was performed are associated with
Radiotherapy is often used in combination with surgery DSS. In addition, we developed the first retroperitoneal MLPS/
and allows for preoperative, intraoperative, or postoperative RCLPS prognostic prediction model. By dividing patients into
radiotherapy. Preoperative radiotherapy may enable surgery three risk categories, it may useful for outpatient consultations
for unresectable tumors. Different liposarcoma subtypes and patient selection for clinical trials.
differ in their sensitivity to radiotherapy, and MLPS is highly Acknowledgments
radiosensitive [42]. Neoadjuvant radiotherapy is mostly used in
patients with mucoid LPS because of its great radiosensitivity. The authors would like to thank all patients and staff who have
The effects of radiotherapy may be initiated by reducing the participated in the SEER program.
DOI: https://doi.org/10.36922/jctr.00113