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RESEARCH PRODUCT
High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial
Paolo G. CasaliSandro PasqualiPiero PicciRita De SanctisAngelo Paolo Dei TosVittorio QuagliuoloStefano FerrariGiovanni GrignaniAlessandro ComandoneAntonio Llomboart-boschAndres PovedaJosefina Cruz JuradoAntonino De PaoliAntonio Lopez-pousaJavier Martin-brotoChiara ColomboSilvia StacchiottiElena PalassiniPaolo VerderioDario CallegaroAlessandro GronchiSara Pizzamigliosubject
0301 basic medicineOncologyAdultMalemedicine.medical_specialtyCancer ResearchAdolescentTumour responsePerioperative Care03 medical and health sciencesYoung Adult0302 clinical medicineInternal medicineAntineoplastic Combined Chemotherapy ProtocolsOutcome Assessment Health Caremedicinemedia_common.cataloged_instanceHumansChemotherapyEuropean unionSurvival ratemedia_commonAgedSoft tissue sarcomabusiness.industryChemotherapy; Choi criteria; Neoadjuvant; Prognosis; Soft tissue sarcoma; Tumour response; Oncology; Cancer ResearchSoft tissue sarcomaIncidence (epidemiology)SarcomaNomogramMiddle Agedmedicine.diseasePrognosisClinical trialSurvival RateNomograms030104 developmental biologyChoi criteriaOncology030220 oncology & carcinogenesisFemaleSarcomaNeoadjuvantRisk assessmentbusinessFollow-Up Studiesdescription
Background: Patients with extremity and trunk wall soft tissue sarcoma (STS) with high malignancy grade and size >5 cm are at high-risk of death. This risk varies depending also on other patient and tumour features, including histologic subtype. This study investigated whether a prognostic nomogram can improve risk assessment of these patients. Methods: Data from high-risk STS patients enrolled in a randomised controlled trial investigating different perioperative chemotherapy regimens were analysed. Ten-year probability of overall survival (OS) and incidence of distant metastasis (DM) were computed using the prognostic nomogram Sarculator (pr-OS and inc-DM, respectively). Tumour response according to RECIST and Choi criteria was also investigated. Findings: Variation in pr-OS and inc-DM were observed and patients stratified in three prognostic groups. The 10-year OS in the low, intermediate, and high pr-OS categories were 0.42 (95%CI 0.32-0.52), 0.63 (95%CI 0.53-0.72), and 0.78 (95%CI 0.68-0.85), respectively. Patients in the intermediate (HR 0.51, P = 0.002) and high (HR 0.28, P < 0.001) pr-OS categories were at statistically significant lower risk of death compared with those in the low pr-OS category. Higher rate of Choi partial tumour responses were detected in intermediate pr-OS category. Tumour response according to Choi but not to RECIST criteria stratified patient survival of pr-OS categories, particularly for patients with intermediate to low pr-OS. Analyses conducted for 10-year inc-DM were consistent with results for pr-OS for prognostic value of Sarculator predictions and Choi tumour response. Interpretation: Sarculator identifies variations in outcomes of high-risk STS treated with perioperative chemotherapy and improve prognostic classification, which is also associated with different patterns of tumour response, an outcome that further stratifies survival particularly for patients predicted at higher risk. Future trials investigating neoadjuvant chemotherapy should consider prognostic tool for selecting patients to be enrolled. (C) 2018 Elsevier Ltd. All rights reserved.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2018-01-01 |