Complete pathological response to neoadjuvant treatment is associated with better survival outcomes in patients with soft tissue sarcoma: Results of a retrospective multicenter study |
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| Affiliation: | 1. Department of Surgery, Institut Curie, Paris University, Paris, France;2. Department of Surgery, Sinai Health System, Toronto, Ontario, Canada;3. Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy;4. Department of Medical Oncology, Hospital Virgen Del Rocio, And Institute of Biomedicine of Sevilla (IBIS) (HUVR, CSIC, University of Sevilla), Sevilla, Spain;5. Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada;6. Department of Surgical Oncology, Istituto Oncologico Veneto, Padova, Italy;7. Department of Oncology, Honved Hospital - Hungarian Defence Forces Military Hospital, Budapest, Hungary;8. Department of Medicine III, University Hospital, LMU Munich, Munich, Germany;9. Department of Surgery - Bone and Connective Tissue Tumour Surgery, Jules Bordet Institute, Brussels, Belgium;10. Department of Medical Oncology, Hospital Universitario Sanchinarro, Centro Integral Oncológico Clara Campal HM CIOCC, Madrid, Spain;11. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland;12. Health Economics & Outcome Research Team, Monitor Deloitte, Zaventem, Belgium;1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;2. Division of Surgery, Danderyd Hospital, Stockholm, Sweden;3. Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden;4. Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden;1. Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, University Medical Center Halle, Halle, Germany;2. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany;3. Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland;4. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;5. Institute for Pathology, Industriestr. 11c, 67063, Ludwigshafen, Germany |
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| Abstract: | BackgroundLocally advanced soft tissue sarcoma (STS) management may include neoadjuvant or adjuvant treatment by radiotherapy (RT), chemotherapy (CT) or chemoradiotherapy (CRT) followed by wide surgical excision. While pathological complete response (pCR) to preoperative treatment is prognostic for survival in osteosarcomas, its significance for STS is unclear. We aimed to evaluate the prognostic significance of pCR to pre-operative treatment on 3-year disease-free survival (3y-DFS) in STS patients.MethodsThis is an observational, retrospective, international, study of adult patients with primary non-metastatic STS of the extremities and trunk wall, any grade, diagnosed between 2008 and 2012, treated with at least neoadjuvant treatment and surgical resection and observed for a minimum of 3 years after diagnosis. The primary objective was to evaluate the effect of pCR. (≤5% viable tumor cells or ≥95% necrosis/fibrosis) on 3y-DFS. Effect on local recurrence-free survival (LRFS), distant recurrence-free survival (MFS) overall survival (OS) at 3 years was also analyzed. Statistical univariate analysis utilized chi-square independence test and odds ratio confidence interval (CI) estimate, multivariate analysis was performed using LASSO.ResultsA total of 330 patients (median age 56 years old, range:19–95) treated by preoperative RT (67%), CT (15%) or CRT (18%) followed by surgery were included. pCR was achieved in 74/330 (22%) of patients, of which 56/74 (76%) had received RT. 3-yr DFS was observed in 76% of patients with pCR vs 61% without pCR (p < 0.001). Multivariate analysis showed that pCR is statistically associated with better MFS (95% CI, 1.054–3.417; p = 0.033), LRFS (95% CI, 1.226–5.916; p = 0.014), DFS (95% CI, 1.165–4.040; p = 0.015) and OS at 3 years (95% CI, 1.072–5.210; p = 0.033).ConclusionsIn a wide, heterogeneous STS population we showed that pCR to preoperative treatment is prognostic for survival. |
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| Keywords: | Sarcoma Surgery Preoperative treatment Pathological response Survival outcomes Retrospective study |
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