Clinical Diagnosis And Treatment Of 120 Cases Of Primary Retroperitoneal Tumor

Objective:Primary Retroperitoneal Tumor(PRPT)is a rare,multidifferentiated,abdominal Tumor.Surgery is the main treatment method,the effects of adjuvant therapies such as chemoradiotherapy remains to be further explored.The local recurrence of tumor is closely related to the prognosis.This paper mainly analyzed the prognosis and diagnosis and treatment experience of primary retroperitoneal tumor in the first affiliated hospital of nanchang university.Methods:Data of the patients with retroperitoneal tumors diagnosed in the first affiliated hospital of Nanchang university from January 2009 to June 2019 were analyzed retrospectively.The data were collected including: basic information(name,sex,age,contact information);Clinical data including medical history,surgical treatment,pathological results and laboratory results,examination results including pre-operative creatinine,bilirubin,albumin,hemoglobin,leukocyte,blood group(ABO),tumor antigen.The outcome of patient and telephone follow-up,and the end point of follow-up: death and loss of follow-up were required.Independent sample T-test was used for measurement data,chi-square test was used for counting data,kaplan-meier method was used for survival analysis,COX regression model was used for multivariate analysis of survival time,P<0.05 was considered statistically significant,and SPSS17.0 was used for statistical analysis.Results:201 cases were enrolled,and the remaining 120 cases were screened by inclusion and exclusion criteria,including 68 males and 52 females.The ratio of men to women is 1.30 to 1.Age range from 11-83 years old,with an average age of49.4±14.9 years.The average hosptial stay was 13.0±6.72 days.Common clinical symptoms were: abdominal pain(38.7%),physical findings(40.3%),abdominal mass(11.8%).The auxiliary examinations were mainly abdominal color ultrasound,CT and MRI,and DSA was performed for in case of necessary.Laboratory examination:tumor markers were tested in 73 patients,of which 25 were elevated.CA-199 increased in 8 cases(32%).CA-125 increased in 10 cases(40%),CEA increased in 4cases(16%),and AFP increased(12%).The patient blood types were O 75/120(62.5%)and A 20/120(16.7%).Surgical treatment included open surgery in 80 cases(67%),laparoscopic surgery in 40 cases(33%),and postoperative radiotherapy in 3cases,which were not included in the analysis.Postoperative pathological results:tumor diameter was 6.8±3.8cm;Complete resection was performed in 103 patients(85.8%),R1 resection in 12 patients(10%),and R2 resection in 5 patients(4%).There were 64 cases of benign tumor(53.8%)and 56 cases of malignant retroperitoneal tumor(46.6%).The ratio of total resection of benign tumor was 62/64(96.8%).Complete resection of malignant tumor was 42/56(75%),and combined resection of viscera was performed in 15 patients(12.5%).Follow-up results: 64 cases of benign retroperitoneal tumor,1 case of death(cause of death unrelated to tumor,accidental death),the 5-year survival rate after tumor surgery was 98.4%.There were 56 cases of malignant retroperitoneal tumors and 30 deaths.The 1,3 and 5year survival rates were85.7%,71.4% and 46.7%.The survival rate at 1,3,and 5 years after complete resection was 89.7%,82%,and 64% in the complete resection group according to whether the malignant tumor was completely resected or not.The 1year,3year and5 year survival rates of the incomplete resection group were 70.6%,52.9% and 11.7%.Single factor analysis results showed that the male,ways of operation(carefully explain such a definition of operation way,there is relationship),tumor diameter(>10 cm),whether complete resection,whether a history of retroperitoneal tumor resection,pathological types of tumors,the location of the tumor(upper abdomen or lower abdomen)as risk factors for malignant tumor.Multivariate analysis showed that resectability of tumors,the maximum diameter of the tumor,a history of recurrence as well as the location of the tumor were the independent prognostic factors.Conclusion:1.The clinical manifestations of retroperitoneal tumors were not typical,Thefinding are found in physical examination.Abdominal pain and abdominal masses were common in patient complaint.Preoperative imaging diagnosis can help to differentiate,among which the diagnosis rate of MRI and CT was higher,and the diagnosis rate of B-ultrasound and DR plain abdominal film was slightly lower,and it was easy to be interfered by other factors.2.Among the pathological types of retroperitoneal tumors in our center,paraganglioma and schwannoma were common in benign tumors.The malignant tumor is liposarcoma.In patients with retroperitoneal tumors,most of them were O blood type,while overall survival(OS)was independent of blood type.3.In all surgical treatments,the princip of complete resection of retroperitoneal tumor should be performed as possible,which is closely related to the prognosis.Compared with malignancy,benign PRPT had a better survival prognosis.In malignant tumors.The cases of combined organ resection were only a small part of the whole(12.5%),and the presence or absence of organ resection was not directly related to the prognosis,but the pathological type of the primary lesion was helpful to predict the infiltration of the resected organ.4.Local recurrence is prone to occur after PRPT,which is closely related to the patient's long-term prognosis.The liposarcoma had the highest rate of recurrence.Regular follow-up 6 months to 1 year after the operation and prompt reoperation to treat recurrence can improve the overall survival rate.