High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial
Por:
Pasquali, S, Colombo, C, Pizzamiglio, S, Verderio, P, Callegaro, D, Stacchiotti, S, Broto, JM, Lopez-Pousa, A, Ferrari, S, Poveda, A, De Paoli, A, Quagliuolo, V, Jurado, JC, Comandone, A, Grignani, G, De Sanctis, R, Palassini, E, Llomboart-Bosch, A, Dei Tos, AP, Casali, PG, Picci, P, Gronchi, A
Publicada:
1 abr 2018
Resumen:
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.
Filiaciones:
Pasquali, S:
Fdn IRCCS Ist Nazl Tumori, Dept Surg, Via G Venezian 1, I-20013 Milan, Italy
Colombo, C:
Fdn IRCCS Ist Nazl Tumori, Dept Surg, Via G Venezian 1, I-20013 Milan, Italy
Pizzamiglio, S:
Fdn IRCCS Ist Nazl Tumori, Unit Med Stat Biometry & Bioinformat, Milan, Italy
Verderio, P:
Fdn IRCCS Ist Nazl Tumori, Unit Med Stat Biometry & Bioinformat, Milan, Italy
Callegaro, D:
Fdn IRCCS Ist Nazl Tumori, Dept Surg, Via G Venezian 1, I-20013 Milan, Italy
Stacchiotti, S:
Fdn IRCCS Ist Nazl Tumori, Dept Canc Med, Milan, Italy
Broto, JM:
Hosp Univ Virgen del Rocio, Dept Canc Med, Seville, Spain
Lopez-Pousa, A:
Hosp Santa Creu & Sant Pau, Dept Canc Med, Barcelona, Spain
Ferrari, S:
Ist Ortoped Rizzoli, Dept Canc Med, Bologna, Italy
Poveda, A:
Valencian Oncol Inst, Dept Canc Med, Valencia, Spain
De Paoli, A:
Ctr Riferimento Oncol, Dept Radiat Oncol, Aviano, Italy
Quagliuolo, V:
Humanitas Canc Ctr, Dept Surg, Rozzano, Italy
Jurado, JC:
Univ Canarias Hosp, Dept Canc Med, San Cristobal la Laguna, Spain
Comandone, A:
Presidio Sanitario Gradenigo, Dept Canc Med, Turin, Italy
Grignani, G:
IRCCS Fdn Piemontese Ric Canc, Dept Canc Med, Candiolo, Italy
De Sanctis, R:
Humanitas Canc Ctr, Dept Canc Med, Rozzano, Italy
Palassini, E:
Fdn IRCCS Ist Nazl Tumori, Dept Canc Med, Milan, Italy
Llomboart-Bosch, A:
Univ Valencia, Dept Pathol, Sch Med, Valencia, Spain
Dei Tos, AP:
Univ Padula, Sch Med, Dept Med, Padua, Italy
Casali, PG:
Fdn IRCCS Ist Nazl Tumori, Dept Canc Med, Milan, Italy
Picci, P:
Ist Ortoped Rizzoli, Lab Oncol Res, Bologna, Italy
Gronchi, A:
Fdn IRCCS Ist Nazl Tumori, Dept Surg, Via G Venezian 1, I-20013 Milan, Italy
|