Liposarcomas are malignant soft tissue tumours with heterogeneous features and variable prognosis. Each entity comprised in this group displays distinct morphology and harbours specific genetic alterations, which correlate with clinical behaviour and therapy response. The aim of this study is to analyse the clinical and histopathological features that can influence the prognosis of liposarcoma. We also present a newly designed scoring system that could be useful for predicting the risk of disease progression and death in patients with different liposarcoma subtypes.

We carried out a retrospective multicentric study on 77 liposarcomas diagnosed between 2009 and 2023 that were followed up to assess the presence of metastases and survival of the patients. We evaluated the age, gender, tumour location and dimensions, histological subtype, mitotic index, presence and percentage of necrosis, and their association with disease progression and survival.

In this respect, progression-free survival was positively associated with lower mitotic index, somatic soft-tissue localization, well-differentiated and myxoid subtypes and absence of necrosis. Overall survival was negatively influenced by older age, higher mitotic index, dedifferentiated and pleomorphic subtypes and the presence of necrosis. Therefore, several clinical and histopathological features of liposarcomas, such as tumour location, mitotic index, and tumour necrosis can strongly predict the disease evolution.

This study focuses on developing a new scoring system that considers histologic subtype, mitotic index, and tumour necrosis as indicators that could predict the risk of disease progression and overall survival in patients with liposarcoma. The system classifies liposarcomas of any histological subtype into low-risk and high-risk tumours. Diagnosing liposarcomas using this two-tiered system could be useful for providing personalized therapy, in order to avoid relapses, metastases and improve the disease's prognosis.

Gastric liposarcoma (GL) is extremely rare and radical surgery has been the conventional treatment, even in small tumors. Laparoscopic wedge resection has been reported worldwide for subepithelial tumors of the stomach.

The patient was an asymptomatic 63-year-old man presenting with a subepithelial gastric tumor. The esophagogastroduodenoscopy showed a 3 cm ulcerated soft tumor located in the posterior wall of the antrum just above the pylorus. Two preoperative biopsies were performed with a negative result for malignant neoplasm. Dynamic computerized tomography revealed 35 × 35 mm well-defined pyloric mass with fat density. Despite the difficult location of the tumor, function-preserving surgery was performed. Surgery was initiated by a laparoscopic approach with four trocars. After the dissection of the greater omentum, the greater curvature and the posterior wall of the stomach were exposed. A gastrostomy was performed in the anterior wall of the antrum. Due to the difficulty in identifying the tumor location, a mini-laparotomy was conducted. After assessing the pylorus and section parameters, the tumor was extracted by gastrostomy and resected with a linear stapler. The patient was discharged after five days with no complications. The histological diagnosis was a well-differentiated liposarcoma. Resection margins were clear. The tumor cells tested negative for MDM2. No adjuvant therapy was indicated. The patient is alive without recurrence.

Despite its rarity, gastric liposarcoma should be respected for differential diagnosis in submucosal tumors. The main diagnostic method is histological, and surgery is the conventional treatment without yet having a consensus. Minimally invasive wedge resection might be a suitable treatment even if the location is close to the pylorus. Multicenter studies are required to obtain better results in the management of this pathology.

Multidisciplinary team collaboration in the diagnosis of rare tumors such as parosteal lipoma is highly important, especially when suspicious of malignancy. The use of radiological and physical examinations is imperative to monitor recurrence and quality of life.

The short-term (≤ 1 year) recurrence (STR) is the primary determinant impacting both the life quality and survival duration in patients who have undergone surgical resection for retroperitoneal liposarcoma (RPLS), a condition with intricate and ambiguous pathogenesis. The purpose of this study was to analyze the risk factors associated with STR in cases of RPLS and primary retroperitoneal liposarcoma (PRPLS).

For this retrospective observational study, a total of 296 RPLS cases were selected as research subjects, who experienced tumor recurrence during the follow-up period. The Local recurrence-free survival (LRFS) rates were estimated using the Kaplan-Meier method and subsequently compared between groups utilizing the log-rank test. The subsequent analyses involved univariate and multivariate logistic regression to identify predictors of STR in RPLS cases. Additionally, a logistic regression model was constructed for PRPLS.

The 1-, 3-, and 5-year LRFS rates of the 296 RPLS cases were 51.7%, 16.9%, and 7.1%, respectively. In the univariate analysis, several factors were found to be associated with STR, including preoperative neutrophil/lymphocyte ratio (NLR), smoking history, surgical frequency, combined organ excision, operative time, intraoperative bleeding, transfer to the intensive care unit (ICU), multiple primary tumors, tumor shape and capsule characteristics, histological subtype, and presence of tumor necrosis. The elevated preoperative NLR, surgical frequency of ≥ 3 times, transfer to the ICU, presence of multiple primary tumors, and tumor necrosis were identified as independent risk factors for STR in surgically resected RPLS. Conversely, diabetes, intact tumor capsule, and well-differentiated histological subtype appeared to be independent protective factors. Analysis for PRPLS revealed that tumor capsule and tumor necrosis were independent predictors of STR.

The elevated preoperative NLR, surgical frequency of ≥ 3 times, transfer to the ICU, presence of multiple primary tumors, tumor necrosis, and tumor capsule were expected to serve as predictive factors of STR for surgical resected RPLS and PRPLS.

Liposarcomas are rare in the orbit. We analyzed a series of primary liposarcomas to determine the features unique to the orbit.

Records from 10 Chinese patients treated for primary orbital liposarcoma at Beijing Tongren Hospital, Capital Medical University, between September 2009 and September 2020 were reviewed.

This cohort included four men and six women with age of onset ranging from 18 to 80 years. The pathology was myxoid liposarcoma in five patients, dedifferentiated liposarcoma in two patients, well-differentiated liposarcoma and pleomorphic liposarcoma in one patient each, and dedifferentiated liposarcoma and well-differentiated liposarcoma co-existing in one case. Magnetic resonance imaging (MRI) revealed a well-defined, irregular, or lobulated mass in the orbit, which contained components that were suppressible in the fat-suppression sequence, as well as components that were enhanced by gadolinium enhancement. Nine patients relapsed after surgery, with a mean recurrence of 2.44, and one patient was lost to follow-up. The interval between treatment and first recurrence ranged from 4 months to 16 years; 55.6% of patients with orbital liposarcoma relapsed within one year. Three patients underwent local excision alone, four patients underwent excision combined with radiotherapy, and three patients underwent exenteration. Half of the patients were misdiagnosed in the pathologic diagnosis after their first or multiple surgeries. No distant metastasis, death from tumors, or invasion of adjacent organs was observed after 21-150 months of follow-up.

Orbital liposarcoma is easily misdiagnosed and prone to recurrence; however, MRI findings may help identify orbital liposarcoma prior to surgery. The optimal treatment choice remains to be discussed.

As the leading cause of mortality for retroperitoneal liposarcoma (RPLS) cases, postoperative recurrence has complicated and unclear risk factors. This study was conducted to explore the correlations between demographic, surgical, and pathological characteristics with local recurrence-free survival (LRFS) for surgical resected RPLS.

RPLS cases that underwent radical operation were considered to be included in this analysis. LRFS rates were estimated based on the Kaplan-Meier method and were compared between groups by the log-rank test. Cox proportional hazard regression models were constructed to identified the predictors of LRFS. Subsequently, the independent predictors acquired from multivariate analyses were used to construct a nomogram.

348 RPLS cases who underwent radical operation were included. Of the 348 cases, 333 had tumor recurrence or with a follow-up period ≥5 years. Thus, 296 (88.9%) of the 333 cases had recurrent disease, and the median LRFS duration of 296 recurrence cases was 17.0 (95% confidence interval (CI) 13.2-20.8) months. Multivariate analysis identified the preoperative neutrophil/lymphocyte ratio (NLR), surgical frequency, operative time, tumor shape, histological subtype, and tumor necrosis as independent predictors of LRFS. Based on above independent predictors, a nomogram was constructed to predict the 1-, 3-, and 5-year LRFS of surgical resected RPLS.

Elevated preoperative NLR, ≥2nd time surgical frequency, extended operation time, irregular tumor shape, no well-differentiated histological subtype, and tumor necrosis could be used as predictors of LRFS for surgical resected RPLS.

Since primary retroperitoneal liposarcoma (PRPLS) is rare in the clinic, related clinical studies are lacking. The present study was designed to investigate the predictive factors of short-term (≤1 year) recurrence (STR) and construct a novel nomogram of local recurrence-free survival (LRFS) for surgically resected PRPLS. A total of 128 PRPLS cases who underwent radical surgery were retrospectively analyzed. Based on the interval from the operation to tumor recurrence, the predictors of STR were screened using univariate and multivariate logistic regression analyses. Cox proportional hazard regression models were applied to identify the predictors of LRFS. Furthermore, the independent predictors acquired from multivariate analyses were used to construct a nomogram. Multivariate logistic regression analysis revealed that age ≥55 years [odds ratio (OR)=5.607, P=0.010], operative time ≥260 min (OR=9.716, P=0.005) and tumor necrosis (OR=3.781, P=0.037) were independent risk factors of STR for PRPLS. In the Cox regression analysis, clinical symptoms [hazard ratio (HR)=1.746, P=0.017], resection method (OR=0.370, P=0.021) and de-differentiated histological subtype (HR=1.975, P=0.048) were identified as independent predictors of LRFS. Subsequently, the independent predictors acquired from multivariate analyses were used to construct a nomogram for LRFS. Age, operative time, tumor necrosis, clinical symptoms, resection method and histological subtype were related to recurrence for surgically resected PRPLS and a novel nomogram was constructed based on the above predictors.

This investigation aimed to explore the relationship between sarcopenia and severe postoperative complications, relapse-free survival (RFS), and overall survival (OS) in patients with retroperitoneal liposarcoma (RLPS).

This retrospective study included 72 RLPS patients (47 men, 25 women; mean age, 57.49 years, SD 10.92) who had abdominal CT exams. Clinical information was recorded, including RLPS characteristics (histologic subtypes, grade, size), laboratory assessment (ALB, PALB, A/G, Hb, SCr), relapse-free survival, overall survival, and postoperative complications. The relationships between those variables and RFS and OS were analyzed using Cox proportional hazard models.

There were 8 severe postoperative complications (Clavien-Dindo grade > 2). The chi-square test showed sarcopenia was associated with severe postoperative complications (P = 0.011). In multivariate analysis, sarcopenia was not associated with relapse-free survival (P = 0.574) and overall survival (P = 0.578).

Sarcopenia predicts worse surgical complications but does not affect relapse-free survival and overall survival.

Soft tissue sarcomas (STSs) are rare tumors that represent almost 1% of adult malignant tumors. The annual incidence rate for such tumors is 2 - 5/100,000 population. The most common type of STS in adults is liposarcoma, which represents 15-20% of adult STSs. It is of mesodermic origin derived from adipose tissues, and known as the most common primary malignant tumor of the retroperitoneum. Other sites of involvement include the extremities, trunk and to a lesser extent the pleural cavity, esophagus, mediastinum and others. Due to the potential large retroperitoneal space, retroperitoneal liposarcoma (RPL) is usually asymptomatic during the initial phase, developing symptoms at a late stage due to large mass compressing nearby retroperitoneal structures. The average diameter and weight of RPL during diagnosis is 20 - 25 cm and 15 - 20 kg, respectively. Several factors were labelled as risk factors for recurrence, such as histological type, tumor grade, age, resectability and tumor size. Controversy exists regarding the relationship between tumor size and recurrence rate, thus, tumor size as a risk factor for recurrence should be clarified. Although there is no consensus regarding the precise definition of giant RPL, it is defined by several literatures as an RPL of greater than 30 cm in diameter or with weight of more than 20 kg. The main purpose of this article is to review the current English literature regarding giant RPL and examine the relationship between tumor size and risk for recurrence.

Retroperitoneal liposarcoma (RLPS) is a rare malignant tumor of the connective tissue and usually grows to a large size, undetected. Diagnosis is currently based on collective findings from clinical examinations and computed tomography (CT) and magnetic resonance imaging, the latter of which show a fat density mass and possible surrounding organ involvement. Surgical resection is the main therapeutic strategy. The efficacy and safety of further therapeutic choices, such as chemotherapy and radiotherapy, are still controversial.

A 61-year-old man presented with complaint of a large left inguinal mass that had appeared suddenly, after a slight exertion. Ultrasonography revealed an omental inguinal hernia. During further clinical examination, an enormous palpable abdominal mass, continuing from the left inguinal location, was observed. CT revealed a giant RLPS, with remarkable mass effect and wide visceral dislocation. After multidisciplinary consultation, surgical intervention was performed. Subsequent neoadjuvant chemotherapy and radiotherapy were precluded by the mass' large size and retroperitoneal localization, features typically associated with non-response to these types of treatment. Instead, the patient underwent conservative treatment via radical surgical excision. After 1 year, his clinical condition remained good, with no radiological signs of recurrence.

Conservative treatment via surgery resulted in a successful outcome for a large RLPS.

Retroperitoneal liposarcomas (RPLs), sarcoma of mesenchymal origin, are the most common soft tissue sarcomas (STS) of the retroperitoneum. Given the rarity of RPLs, the prognostic values of clinicopathological features in the patients remain unclear. The nomogram can provide a visual interface to aid in calculating the predicted probability that a patient will achieve a particular clinical endpoint and communication with patients.

We included a total of 1,392 RPLs patients diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. For nomogram construction and validation, patients in the SEER database were divided randomly into the training cohort and internal validation cohort at a ratio of 7:3, while 65 patients with RPLs from our center between 2010 and 2016 served as the external validation cohort. The OS curves were drawn using the Kaplan-Meier method and assessed using the log-rank test. Moreover, Fine and Gray's competing-risk regression models were conducted to assess CSS. Univariate and multivariate analyses were performed to select the prognostic factors for survival time. We constructed a predictive nomogram based on the results of the multivariate analyses.

Through univariate and multivariate analyses, it is found that age, histological grade, classification, SEER stage, surgery constitute significant risk factors for OS, and age, classification, SEER stage, AJCC M stage, surgery, and tumor size constitute risk factors for CSS. We found that the nomogram provided a good assessment of OS and CSS at 1, 3, and 5 years in patients with RPLs (1-year OS: (training cohort: AUC = 0.755 (95% CI, 0.714, 0.796); internal validation cohort: AUC = 0.754 (95% CI, 0.681, 0.827); external validation cohort: AUC = 0.793 (95% CI, 0.651, 0.935)); 3-year OS: (training cohort: AUC = 0.782 (95% CI, 0.752, 0.811); internal validation cohort: AUC = 0.788 (95% CI, 0.736, 0.841); external validation cohort: AUC = 0.863 (95% CI, 0.773, 0.954)); 5-year OS: (training cohort: AUC = 0.780 (95% CI, 0.752, 0.808); internal validation cohort: AUC = 0.783 (95% CI, 0.732, 0.834); external validation cohort: AUC = 0.854 (95% CI, 0.762, 0.945)); 1-year CSS: (training cohort: AUC = 0.769 (95% CI, 0.717, 0.821); internal validation cohort: AUC = 0.753 (95% CI, 0.668, 0.838); external validation cohort: AUC = 0.799 (95% CI, 0.616, 0.981)); 3-year CSS: (training cohort: AUC = 0.777 (95% CI, 0.742, 0.811); internal validation cohort: AUC = 0.787 (95% CI, 0.726, 0.849); external validation cohort: AUC = 0.808 (95% CI, 0.673, 0.943)); 5-year CSS: (training cohort: AUC = 0.773 (95% CI, 0.741, 0.805); internal validation cohort: AUC = 0.768 (95% CI, 0.709, 0.827); external validation cohort: AUC = 0.829 (95% CI, 0.712, 0.945))). The calibration plots for the training, internal validation, and external validation cohorts at 1-, 3-, and 5-year OS and CSS indicated that the predicted survival rates closely correspond to the actual survival rates.

We constructed and externally validated an unprecedented nomogram prognostic model for patients with RPLs. The nomogram can be used as a potential, objective, and supplementary tool for clinicians to predict the prognosis of RPLs patients around the world.