- 作者：Sarah B. Fisher ; Katherine J. Baxter ; Charles A. Staley III ; Kevin E. Fisher ; David K. Monson ; Douglas R. Murray ; Shervin V. Oskouei ; Sharon W. Weiss ; David A. Kooby ; Shishir K. Maithel ; Keith A. Delman
- 关键词：ALT ; atypical lipomatous tumor ; DDLS ; dedifferentiated liposarcoma ; HR ; hazard ratio ; ICD-9-CM ; International Classification of Diseases ; ninth revision ; clinical modification ; WDLS ; well-differentiated liposarcoma
- 刊名：Journal of the American College of Surgeons
- 出版年：2013
- 出版时间：November, 2013
- 年：2013
- 卷：217
- 期：5
- 页码：881-888
- 全文大小：301 K
Background
Differentiating large lipomas from atypical lipomatous tumors (ALT) is challenging, and preoperative management guidelines are not well defined. The diagnostic ambiguity leads many surgeons to refer all patients with large lipomatous masses to an oncologic specialist, perhaps unnecessarily.Study Design
In this retrospective cohort study of patients with nonretroperitoneal lipomatous tumors, preoperative characteristics discernible without invasive diagnostic procedures were evaluated for diagnostic predictive value.
Results
We identified 319 patients (256 with lipomas, 63 with ALTs) treated between 1994 and 2012. Patients with ALTs were older (60.5 vs 53.5 years, p < 0.0001), had larger tumors (16.0 vs 8.3 cm, p < 0.0001), had tumors more often located on an extremity (88.9 % vs 60.5 % torso, p < 0.0001), and more frequently had a history of previous operations at the same site, exclusive of excision leading to diagnosis and referral (20.6 % vs 5.9 % , p?= 0.001). Local recurrence was observed in 2 patients with lipomas (0.8 % ) vs 14 with ALTs (22.6 % , p < 0.0001). No patients with ALTs developed distant metastases or disease-specific mortality, with a median follow-up of 27.4 months (range 0 to 164.6 months). On multivariate analysis, age ¡Ý55 years, tumor size ¡Ý10 cm, extremity location, and history of previous resections were predictors for diagnosis of ALT (p < 0.05).
Conclusions
Characteristics of lipomatous masses associated with a diagnosis of ALT include patient age ¡Ý55 years, tumor size ¡Ý10 cm, previous resection, and extremity location (vs torso). These easily identifiable traits may guide surgical management or referral to a specialist.