Pathogenesis and comprehensive treatment of primary retroperitoneal liposarcoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Chuangkun ¹ , ZHOU Xiao ² , LING Jiayu ¹ , ZENG Zhantao ¹ , HUANG Rongkang ¹ ,  WANG Hui ¹

1. The Sixth Affiliated Hospital, Sun Yat-sen University & Guangdong Provincial Institute of Gastroenterology & Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou 510655, P. R. China;
2. Yanbu Hospital, Nanhai District of Foshan City, Foshan, Guangdong 528247, P. R. China;

Corresponding author：

WANG Hui, Email: wanghuislh@hotmail.com

Keywords：

retroperitoneal liposarcoma; pathogenesis; treatment

DOI：

10.7507/1007-9424.201906095

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the pathogenesis and the research progress of comprehensive treatment of primary retroperitoneal liposarcoma (PRLPS) and to provide evidence for clinical diagnosis and treatment.Method The recent literatures on the pathological classification, pathogenesis of PRLPS, and comprehensive treatment including the surgery, radiotherapy, chemotherapy, and molecular targeted therapy were reviewed.Results The pathological types of PRLPS were highly differentiated, dedifferentiated, mucoid/round cell, polymorphic, and mixed. The main molecular pathogenesis was the synergistic effect of MDM2 with related genes, abnormal expressions of c-myc gene and microRNAs, Prune-nm23-H1 mechanism, and abnormal protein products of FUS-CHOP fusion gene which regulated the growth of tumor. The treatment of PRLRS included the radical resection, extended resection, and palliative resection combined with radiotherapy, chemotherapy, and molecular targeted therapy.Conclusions PRLPS is a rare malignant tumor with high recurrence rate, but early diagnosis and treatment are difficult. With the further study of the molecular mechanism of PRLPS, the treatment of PRLPS has been transformed into a comprehensive treatment based on surgery, adjuvant radiotherapy and chemotherapy, and molecular targeted therapy.

Citation： LI Chuangkun, ZHOU Xiao, LING Jiayu, ZENG Zhantao, HUANG Rongkang, WANG Hui. Pathogenesis and comprehensive treatment of primary retroperitoneal liposarcoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(4): 504-509. doi: 10.7507/1007-9424.201906095 Copy

1.	Zhao X, Li P, Huang X, et al. Prognostic factors predicting the postoperative survival period following treatment for primary retroperitoneal liposarcoma. Chin Med J (Engl), 2015, 128(1): 85-90.
2.	侯雷, 蹇令国, 卢灿荣, 等. 原发性腹膜后脂肪肉瘤的综合治疗. 中国医师进修杂志, 2017, 40(3): 278-281.
3.	Vijay A, Ram L. Retroperitoneal liposarcoma: a comprehensive review. Am J Clin Oncol, 2015, 38(2): 213-219.
4.	张少波, 张诚华. 原发性腹膜后肿瘤的诊断与治疗. 临床军医杂志, 2004, 32(3): 104-106.
5.	中国研究型医院学会腹膜后与盆底疾病专业委员会. 腹膜后脂肪肉瘤诊断和治疗专家共识(2016). 中国微创外科杂志, 2016, 16(12): 1057-1063.
6.	Raut CP, Callegaro D, Miceli R, et al. Predicting survival in patients undergoing resection for locally recurrent retroperitoneal sarcoma: A study and novel nomogram from TARPSWG. Clin Cancer Res, 2019, 25(8): 2664-2671.
7.	Peacock O, Patel S, Simpson JA, et al. A systematic review of population-based studies examining outcomes in primary retroperitoneal sarcoma surgery. Surg Oncol, 2019, 29: 53-63.
8.	Lahat G, Tuvin D, Wei C, et al. New perspectives for staging and prognosis in soft tissue sarcoma. Ann Surg Oncol, 2008, 15(10): 2739-2748.
9.	董雅楠, 邱法波, 于炳奇, 等. 腹膜后脂肪肉瘤研究进展. 中国现代普通外科进展, 2018, 21(4): 292-297.
10.	Borjigin N, Ohno S, Wu W, et al. TLS-CHOP represses miR-486 expression, inducing upregulation of a metastasis regulator PAI-1 in human myxoid liposarcoma. Biochem Biophys Res Commun, 2012, 427(2): 355-360.
11.	Ben Salha I, Zaidi S, Noujaim J, et al. Rare aggressive behavior of MDM2-amplified retroperitoneal dedifferentiated liposarcoma, with brain, lung and subcutaneous metastases. Rare Tumors, 2016, 8(3): 6282.
12.	苗海港, 邱法波, 李赞滨, 等. c-myc、MDM2及p53基因在原发性腹膜后脂肪肉瘤中的表达及临床意义. 中国现代普通外科进展, 2014, 17(5): 361-365.
13.	宫丽华, 刘巍峰, 丁宜, 等. 肢体去分化脂肪肉瘤临床病理学分析. 中华病理学杂志, 2018, 47(7): 511-516.
14.	Gao C, Ji J, Yan F, et al. Oscillation induced by Hopf bifurcation in the p53-Mdm2 feedback module. IET Syst Biol, 2019, 13(5): 251-259.
15.	Kohno T, Oyama K, Terai S, et al. A case of retroperitoneal liposarcoma that invaded and filled the jejunal lumen. Gan To Kagaku Ryoho, 2017, 44(12): 1338-1340.
16.	Aleixo PB, Hartmann AA, Menezes IC, et al. Can MDM2 and CDK4 make the diagnosis of well differentiated/dedifferentiated liposarcoma? An immunohistochemical study on 129 soft tissue tumours. J Clin Pathol, 2009, 62(12): 1127-1135.
17.	Llanos S, Efeyan A, Monsech J, et al. A high-throughput loss-of-function screening identifies novel p53 regulators. Cell Cycle, 2006, 5(16): 1880-1885.
18.	Zhang S, Mo Q, Wang X. Oncological role of HMGA2 (Review). Int J Oncol, 2019, 55(4): 775-788.
19.	Mayr C, Hemann MT, Bartel DP. Disrupting the pairing between let-7 and Hmga2 enhances oncogenic transformation. Science, 2007, 315(5818): 1576-1579.
20.	Strickland SW, Vande Pol S. The human papillomavirus 16 E7 oncoprotein attenuates AKT signaling to promote internal ribosome entry site-dependent translation and expression of c-MYC. J Virol, 2016, 90(12): 5611-5621.
21.	季雪梅, 李小燕. mdm2基因在肿瘤中的研究进展. 昆明医学院学报, 2009, 2B(S1): 98-102.
22.	De Cecco L, Negri T, Brich S, et al. Identification of a gene expression driven progression pathway in myxoid liposarcoma. Oncotarget, 2014, 5(15): 5965-5977.
23.	Forus A, D'Angelo A, Henriksen J, et al. Amplification and overexpression of PRUNE in human sarcomas and breast carcinomas—a possible mechanism for altering the nm23-H1 activity. Oncogene, 2001, 20(47): 6881-6890.
24.	Zhao LR, Tian W, Wang GW, et al. The prognostic role of PRUNE2 in leiomyosarcoma. Chin J Cancer, 2013, 32(12): 648-652.
25.	Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet, 2014, 383(9927): 1490-1502.
26.	张林, 高林波. miR-143和miR-145与肿瘤的研究进展. 西安交通大学学报(医学版), 2013, 34(1): 1-6.
27.	Ugras S, Brill E, Jacobsen A, et al. Small RNA sequencing and functional characterization reveals MicroRNA-143 tumor suppressor activity in liposarcoma. Cancer Res, 2011, 71(17): 5659-5669.
28.	Italiano A, Di Mauro I, Rapp J, et al. Clinical effect of molecular methods in sarcoma diagnosis (GENSARC): a prospective, multicentre, observational study. Lancet Oncol, 2016, 17(4): 532-538.
29.	Rabbitts TH, Forster A, Larson R, et al. Fusion of the dominant negative transcription regulator CHOP with a novel gene FUS by translocation t(12;16) in malignant liposarcoma. Nat Genet, 1993, 4(2): 175-180.
30.	Rodriguez R, Tornin J, Suarez C, et al. Expression of FUS-CHOP fusion protein in immortalized/transformed human mesenchymal stem cells drives mixoid liposarcoma formation. Stem Cells, 2013, 31(10): 2061-2072.
31.	Barone MV, Crozat A, Tabaee A, et al. CHOP (GADD153) and its oncogenic variant, TLS-CHOP, have opposing effects on the induction of G1/S arrest. Genes Dev, 1994, 8(4): 453-464.
32.	Dangoor A, Seddon B, Gerrand C, et al. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res, 2016, 6: 20.
33.	曹李, 郗洪庆, 乔治, 等. 多次复发腹膜后脂肪肉瘤30例诊治分析. 人民军医, 2015, 58(11): 1343-1344.
34.	Toulmonde M, Bonvalot S, Méeus P, et al. Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol, 2014, 25(3): 735-742.
35.	陈德, 蒋小峰, 李悦, 等. 原发性腹膜后肿瘤的外科治疗. 中国普通外科杂志, 2003, 12(7): 523-525.
36.	Marinello P, Montresor E, Iacono C, et al. Long-term results of aggressive surgical treatment of primary and recurrent retroperitoneal liposarcomas. Chir Ital, 2001, 53(2): 149-157.
37.	Fairweather M, Gonzalez RJ, Strauss D, et al. Current principles of surgery for retroperitoneal sarcomas. J Surg Oncol, 2018, 117(1): 33-41.
38.	Kelly KJ, Yoon SS, Kuk D, et al. Comparison of perioperative radiation therapy and surgery versus surgery alone in 204 patients with primary retroperitoneal sarcoma: a retrospective 2-institution study. Ann Surg, 2015, 262(1): 156-162.
39.	Ecker BL, Peters MG, McMillan MT, et al. Preoperative radiotherapy in the management of retroperitoneal liposarcoma. Br J Surg, 2016, 103(13): 1839-1846.
40.	Harb AH, Abou Fadel C, Sharara AI. Radiation enteritis. Curr Gastroenterol Rep, 2014, 16(5): 383.
41.	Cheng H, Miura JT, Lalehzari M, et al. Neoadjuvant radiotherapy for retroperitoneal sarcoma: A systematic review. J Surg Oncol, 2016, 113(6): 628-634.
42.	Zhou Z, McDade TP, Simons JP, et al. Surgery and radiotherapy for retroperitoneal and abdominal sarcoma: both necessary and sufficient. Arch Surg, 2010, 145(5): 426-431.
43.	Young RJ, Woll PJ. Eribulin in soft-tissue sarcoma. Lancet, 2016, 387(10028): 1594-1596.
44.	Judson I, Verweij J, Gelderblom H, et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol, 2014, 15(4): 415-423.
45.	Zijoo R, von Mehren M. Efficacy of trabectedin for the treatment of liposarcoma. Expert Opin Pharmacother, 2016, 17(14): 1953-1962.
46.	Schöffski P, Chawla S, Maki RG, et al. Eribulin versus dacarbazine in previously treated patients with advanced liposarcoma or leiomyosarcoma: a randomised, open-label, multicentre, phase 3 trial. Lancet, 2016, 387(10028): 1629-1637.
47.	Tap WD, Jones RL, Van Tine BA, et al. Olaratumab and doxorubicin versus doxorubicin alone for treatment of soft-tissue sarcoma: an open-label phase 1b and randomised phase 2 trial. Lancet, 2016, 388(10043): 488-497.
48.	Pappo AS, Vassal G, Crowley JJ, et al. A phase 2 trial of R1507, a monoclonal antibody to the insulin-like growth factor-1 receptor (IGF-1R), in patients with recurrent or refractory rhabdomyo sarcoma, osteosarcoma, synovial sarcoma, and other soft tissue sarcomas: results of a Sarcoma Alliance for Research Through Collaboration study. Cancer, 2014, 120(16): 2448-2456.
49.	Dong M, Bi J, Liu X, et al. Significant partial response of metastatic intra-abdominal and pelvic round cell liposarcoma to a small-molecule VEGFR-2 tyrosine kinase inhibitor apatinib: A case report. Medicine (Baltimore), 2016, 95(31): e4368.
50.	Italiano A, Bianchini L, Gjernes E, et al. Clinical and biological significance of CDK4 amplification in well-differentiated and dedifferentiated liposarcomas. Clin Cancer Res, 2009, 15(18): 5696-5703.
51.	Min L, Garbutt C, Tu C, et al. Potentials of long noncoding RNAs (LncRNAs) in sarcoma: from biomarkers to therapeutic targets. Int J Mol Sci, 2017, 18(4): pii: E731.
52.	Ding Q, Zhang Z, Liu JJ, et al. Discovery of RG7388, a potent and selective p53-MDM2 inhibitor in clinical development. J Med Chem, 2013, 56(14): 5979-5983.
53.	Blay JY, Casali P, Nieto A, et al. Efficacy and safety of trabectedin as an early treatment for advanced or metastatic liposarcoma and leiomyosarcoma. Future Oncol, 2014, 10(1): 59-68.

1. Zhao X, Li P, Huang X, et al. Prognostic factors predicting the postoperative survival period following treatment for primary retroperitoneal liposarcoma. Chin Med J (Engl), 2015, 128(1): 85-90.
2. 侯雷, 蹇令国, 卢灿荣, 等. 原发性腹膜后脂肪肉瘤的综合治疗. 中国医师进修杂志, 2017, 40(3): 278-281.
3. Vijay A, Ram L. Retroperitoneal liposarcoma: a comprehensive review. Am J Clin Oncol, 2015, 38(2): 213-219.
4. 张少波, 张诚华. 原发性腹膜后肿瘤的诊断与治疗. 临床军医杂志, 2004, 32(3): 104-106.
5. 中国研究型医院学会腹膜后与盆底疾病专业委员会. 腹膜后脂肪肉瘤诊断和治疗专家共识(2016). 中国微创外科杂志, 2016, 16(12): 1057-1063.
6. Raut CP, Callegaro D, Miceli R, et al. Predicting survival in patients undergoing resection for locally recurrent retroperitoneal sarcoma: A study and novel nomogram from TARPSWG. Clin Cancer Res, 2019, 25(8): 2664-2671.
7. Peacock O, Patel S, Simpson JA, et al. A systematic review of population-based studies examining outcomes in primary retroperitoneal sarcoma surgery. Surg Oncol, 2019, 29: 53-63.
8. Lahat G, Tuvin D, Wei C, et al. New perspectives for staging and prognosis in soft tissue sarcoma. Ann Surg Oncol, 2008, 15(10): 2739-2748.
9. 董雅楠, 邱法波, 于炳奇, 等. 腹膜后脂肪肉瘤研究进展. 中国现代普通外科进展, 2018, 21(4): 292-297.
10. Borjigin N, Ohno S, Wu W, et al. TLS-CHOP represses miR-486 expression, inducing upregulation of a metastasis regulator PAI-1 in human myxoid liposarcoma. Biochem Biophys Res Commun, 2012, 427(2): 355-360.
11. Ben Salha I, Zaidi S, Noujaim J, et al. Rare aggressive behavior of MDM2-amplified retroperitoneal dedifferentiated liposarcoma, with brain, lung and subcutaneous metastases. Rare Tumors, 2016, 8(3): 6282.
12. 苗海港, 邱法波, 李赞滨, 等. c-myc、MDM2及p53基因在原发性腹膜后脂肪肉瘤中的表达及临床意义. 中国现代普通外科进展, 2014, 17(5): 361-365.
13. 宫丽华, 刘巍峰, 丁宜, 等. 肢体去分化脂肪肉瘤临床病理学分析. 中华病理学杂志, 2018, 47(7): 511-516.
14. Gao C, Ji J, Yan F, et al. Oscillation induced by Hopf bifurcation in the p53-Mdm2 feedback module. IET Syst Biol, 2019, 13(5): 251-259.
15. Kohno T, Oyama K, Terai S, et al. A case of retroperitoneal liposarcoma that invaded and filled the jejunal lumen. Gan To Kagaku Ryoho, 2017, 44(12): 1338-1340.
16. Aleixo PB, Hartmann AA, Menezes IC, et al. Can MDM2 and CDK4 make the diagnosis of well differentiated/dedifferentiated liposarcoma? An immunohistochemical study on 129 soft tissue tumours. J Clin Pathol, 2009, 62(12): 1127-1135.
17. Llanos S, Efeyan A, Monsech J, et al. A high-throughput loss-of-function screening identifies novel p53 regulators. Cell Cycle, 2006, 5(16): 1880-1885.
18. Zhang S, Mo Q, Wang X. Oncological role of HMGA2 (Review). Int J Oncol, 2019, 55(4): 775-788.
19. Mayr C, Hemann MT, Bartel DP. Disrupting the pairing between let-7 and Hmga2 enhances oncogenic transformation. Science, 2007, 315(5818): 1576-1579.
20. Strickland SW, Vande Pol S. The human papillomavirus 16 E7 oncoprotein attenuates AKT signaling to promote internal ribosome entry site-dependent translation and expression of c-MYC. J Virol, 2016, 90(12): 5611-5621.
21. 季雪梅, 李小燕. mdm2基因在肿瘤中的研究进展. 昆明医学院学报, 2009, 2B(S1): 98-102.
22. De Cecco L, Negri T, Brich S, et al. Identification of a gene expression driven progression pathway in myxoid liposarcoma. Oncotarget, 2014, 5(15): 5965-5977.
23. Forus A, D'Angelo A, Henriksen J, et al. Amplification and overexpression of PRUNE in human sarcomas and breast carcinomas—a possible mechanism for altering the nm23-H1 activity. Oncogene, 2001, 20(47): 6881-6890.
24. Zhao LR, Tian W, Wang GW, et al. The prognostic role of PRUNE2 in leiomyosarcoma. Chin J Cancer, 2013, 32(12): 648-652.
25. Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet, 2014, 383(9927): 1490-1502.
26. 张林, 高林波. miR-143和miR-145与肿瘤的研究进展. 西安交通大学学报(医学版), 2013, 34(1): 1-6.
27. Ugras S, Brill E, Jacobsen A, et al. Small RNA sequencing and functional characterization reveals MicroRNA-143 tumor suppressor activity in liposarcoma. Cancer Res, 2011, 71(17): 5659-5669.
28. Italiano A, Di Mauro I, Rapp J, et al. Clinical effect of molecular methods in sarcoma diagnosis (GENSARC): a prospective, multicentre, observational study. Lancet Oncol, 2016, 17(4): 532-538.
29. Rabbitts TH, Forster A, Larson R, et al. Fusion of the dominant negative transcription regulator CHOP with a novel gene FUS by translocation t(12;16) in malignant liposarcoma. Nat Genet, 1993, 4(2): 175-180.
30. Rodriguez R, Tornin J, Suarez C, et al. Expression of FUS-CHOP fusion protein in immortalized/transformed human mesenchymal stem cells drives mixoid liposarcoma formation. Stem Cells, 2013, 31(10): 2061-2072.
31. Barone MV, Crozat A, Tabaee A, et al. CHOP (GADD153) and its oncogenic variant, TLS-CHOP, have opposing effects on the induction of G1/S arrest. Genes Dev, 1994, 8(4): 453-464.
32. Dangoor A, Seddon B, Gerrand C, et al. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res, 2016, 6: 20.
33. 曹李, 郗洪庆, 乔治, 等. 多次复发腹膜后脂肪肉瘤30例诊治分析. 人民军医, 2015, 58(11): 1343-1344.
34. Toulmonde M, Bonvalot S, Méeus P, et al. Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol, 2014, 25(3): 735-742.
35. 陈德, 蒋小峰, 李悦, 等. 原发性腹膜后肿瘤的外科治疗. 中国普通外科杂志, 2003, 12(7): 523-525.
36. Marinello P, Montresor E, Iacono C, et al. Long-term results of aggressive surgical treatment of primary and recurrent retroperitoneal liposarcomas. Chir Ital, 2001, 53(2): 149-157.
37. Fairweather M, Gonzalez RJ, Strauss D, et al. Current principles of surgery for retroperitoneal sarcomas. J Surg Oncol, 2018, 117(1): 33-41.
38. Kelly KJ, Yoon SS, Kuk D, et al. Comparison of perioperative radiation therapy and surgery versus surgery alone in 204 patients with primary retroperitoneal sarcoma: a retrospective 2-institution study. Ann Surg, 2015, 262(1): 156-162.
39. Ecker BL, Peters MG, McMillan MT, et al. Preoperative radiotherapy in the management of retroperitoneal liposarcoma. Br J Surg, 2016, 103(13): 1839-1846.
40. Harb AH, Abou Fadel C, Sharara AI. Radiation enteritis. Curr Gastroenterol Rep, 2014, 16(5): 383.
41. Cheng H, Miura JT, Lalehzari M, et al. Neoadjuvant radiotherapy for retroperitoneal sarcoma: A systematic review. J Surg Oncol, 2016, 113(6): 628-634.
42. Zhou Z, McDade TP, Simons JP, et al. Surgery and radiotherapy for retroperitoneal and abdominal sarcoma: both necessary and sufficient. Arch Surg, 2010, 145(5): 426-431.
43. Young RJ, Woll PJ. Eribulin in soft-tissue sarcoma. Lancet, 2016, 387(10028): 1594-1596.
44. Judson I, Verweij J, Gelderblom H, et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol, 2014, 15(4): 415-423.
45. Zijoo R, von Mehren M. Efficacy of trabectedin for the treatment of liposarcoma. Expert Opin Pharmacother, 2016, 17(14): 1953-1962.
46. Schöffski P, Chawla S, Maki RG, et al. Eribulin versus dacarbazine in previously treated patients with advanced liposarcoma or leiomyosarcoma: a randomised, open-label, multicentre, phase 3 trial. Lancet, 2016, 387(10028): 1629-1637.
47. Tap WD, Jones RL, Van Tine BA, et al. Olaratumab and doxorubicin versus doxorubicin alone for treatment of soft-tissue sarcoma: an open-label phase 1b and randomised phase 2 trial. Lancet, 2016, 388(10043): 488-497.
48. Pappo AS, Vassal G, Crowley JJ, et al. A phase 2 trial of R1507, a monoclonal antibody to the insulin-like growth factor-1 receptor (IGF-1R), in patients with recurrent or refractory rhabdomyo sarcoma, osteosarcoma, synovial sarcoma, and other soft tissue sarcomas: results of a Sarcoma Alliance for Research Through Collaboration study. Cancer, 2014, 120(16): 2448-2456.
49. Dong M, Bi J, Liu X, et al. Significant partial response of metastatic intra-abdominal and pelvic round cell liposarcoma to a small-molecule VEGFR-2 tyrosine kinase inhibitor apatinib: A case report. Medicine (Baltimore), 2016, 95(31): e4368.
50. Italiano A, Bianchini L, Gjernes E, et al. Clinical and biological significance of CDK4 amplification in well-differentiated and dedifferentiated liposarcomas. Clin Cancer Res, 2009, 15(18): 5696-5703.
51. Min L, Garbutt C, Tu C, et al. Potentials of long noncoding RNAs (LncRNAs) in sarcoma: from biomarkers to therapeutic targets. Int J Mol Sci, 2017, 18(4): pii: E731.
52. Ding Q, Zhang Z, Liu JJ, et al. Discovery of RG7388, a potent and selective p53-MDM2 inhibitor in clinical development. J Med Chem, 2013, 56(14): 5979-5983.
53. Blay JY, Casali P, Nieto A, et al. Efficacy and safety of trabectedin as an early treatment for advanced or metastatic liposarcoma and leiomyosarcoma. Future Oncol, 2014, 10(1): 59-68.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Pathogenesis and comprehensive treatment of primary retroperitoneal liposarcoma

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