Does radiotherapy improve the prognosis of limb liposarcoma? A retrospective study based on propensity score matching

Abstract Purpose This study aimed to assess whether adjuvant radiotherapy (RT) can improve prognosis outcomes in patients with limb liposarcoma (LPS) and to identify independent prognostic factors. To mitigate selection bias, propensity score matching (PSM)was applied between groups in this study. Methods A retrospective analysis was conducted on 153 patients with primary limb LPS treated at a single tertiary center between 2015 and 2023. Patients were divided into RT and non-RT groups. A 1:1 PSM approach was applied to balance 11 baseline covariates between two groups, including age, sex, tumor characteristics etc. Our primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Multivariate Cox regression analysis was used for prognostic factor investigation. Results Among all LPS patients, pre-PSM 5-year OS rates were 88.8% in the non-RT group and 71.1% in the RT group ( p = 0.073), whereas post-PSM 5-year OS rates were 85.2% in the non-RT group and 71.1% in the RT group ( p = 0.33). Pre-PSM analysis revealed that the non-RT group had higher RFS (75.6% vs. 41.8%, p = 0.0015), yet this difference was no longer significant after PSM (64.8% vs. 41.8%, p = 0.091). In the myxoid LPS (MLPS) subgroup, post-PSM RFS was significantly lower in the RT group (48.4% vs. 86.5%, p = 0.0071), but OS remained comparable ( p = 0.16). Multivariate analysis identified older age (HR = 1.06, p = 0.021) as an independent risk factor for mortality after PSM, while RT showed no significant association with survival. Conclusion Adjuvant RT was not associated with improved OS or RFS in patients with limb LPS, even in the radiosensitive MLPS subtype. Age remains a crucial prognostic factor, while the association between chemotherapy and worse survival requires further investigation. Based on our findings, individualized surgical strategies are recommended over routine use of RT in the management of limb LPS.