Extremity Soft Tissue Sarcoma: A Multi-Institutional Validation of Prognostic Nomograms.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
30
04
2021
accepted:
15
11
2021
pubmed:
12
1
2022
medline:
12
4
2022
entrez:
11
1
2022
Statut:
ppublish
Résumé
Prognostic nomograms for patients with resected extremity soft tissue sarcoma (STS) include the Sarculator and Memorial Sloan Kettering (MSKCC) nomograms. We sought to validate these two nomograms within a large, modern, multi-institutional cohort of resected primary extremity STS patients. Resected primary extremity STS patients from 2000 to 2017 were identified across nine high-volume U.S. institutions. Predicted 5- and 10-year overall survival (OS) and distant metastases cumulative incidence (DMCI), and 4-, 8-, and 12-year disease-specific survival (DSS) were calculated with Sarculator and MSKCC nomograms, respectively. Predicted survival probabilities stratified in quintiles were compared in calibration plots to observed survival assessed by Kaplan-Meier estimates. Cumulative incidence was estimated for DMCI. Harrell's concordance index (C-index) assessed discriminative ability of nomograms. A total of 1326 patients underwent resection of primary extremity STS. Common histologies included: undifferentiated pleomorphic sarcoma (35%), fibrosarcoma (13%), and leiomyosarcoma (9%). Median tumor size was 8.0 cm (IQR 4.5-13.0). Tumor grade distribution was: Grade 1 (13%), Grade 2 (9%), Grade 3 (78%). Median OS was 172 months, with estimated 5- and 10-year OS of 70% and 58%. C-indices for 5- and 10-year OS (Sarculator) were 0.72 (95% CI 0.70-0.75) and 0.73 (95% CI 0.70-0.75), and 0.72 (95% CI 0.69-0.75) for 5- and 10-year DMCI. C-indices for 4-, 8-, and 12-year DSS (MSKCC) were 0.71 (95% CI 0.68-0.75). Calibration plots showed good prognostication across all outcomes. Sarculator and MSKCC nomograms demonstrated good prognostic ability for survival and recurrence outcomes in a modern, multi-institutional validation cohort of resected primary extremity STS patients. External validation of these nomograms supports their ongoing incorporation into clinical practice.
Sections du résumé
BACKGROUND
BACKGROUND
Prognostic nomograms for patients with resected extremity soft tissue sarcoma (STS) include the Sarculator and Memorial Sloan Kettering (MSKCC) nomograms. We sought to validate these two nomograms within a large, modern, multi-institutional cohort of resected primary extremity STS patients.
METHODS
METHODS
Resected primary extremity STS patients from 2000 to 2017 were identified across nine high-volume U.S. institutions. Predicted 5- and 10-year overall survival (OS) and distant metastases cumulative incidence (DMCI), and 4-, 8-, and 12-year disease-specific survival (DSS) were calculated with Sarculator and MSKCC nomograms, respectively. Predicted survival probabilities stratified in quintiles were compared in calibration plots to observed survival assessed by Kaplan-Meier estimates. Cumulative incidence was estimated for DMCI. Harrell's concordance index (C-index) assessed discriminative ability of nomograms.
RESULTS
RESULTS
A total of 1326 patients underwent resection of primary extremity STS. Common histologies included: undifferentiated pleomorphic sarcoma (35%), fibrosarcoma (13%), and leiomyosarcoma (9%). Median tumor size was 8.0 cm (IQR 4.5-13.0). Tumor grade distribution was: Grade 1 (13%), Grade 2 (9%), Grade 3 (78%). Median OS was 172 months, with estimated 5- and 10-year OS of 70% and 58%. C-indices for 5- and 10-year OS (Sarculator) were 0.72 (95% CI 0.70-0.75) and 0.73 (95% CI 0.70-0.75), and 0.72 (95% CI 0.69-0.75) for 5- and 10-year DMCI. C-indices for 4-, 8-, and 12-year DSS (MSKCC) were 0.71 (95% CI 0.68-0.75). Calibration plots showed good prognostication across all outcomes.
CONCLUSIONS
CONCLUSIONS
Sarculator and MSKCC nomograms demonstrated good prognostic ability for survival and recurrence outcomes in a modern, multi-institutional validation cohort of resected primary extremity STS patients. External validation of these nomograms supports their ongoing incorporation into clinical practice.
Identifiants
pubmed: 35015183
doi: 10.1245/s10434-021-11205-5
pii: 10.1245/s10434-021-11205-5
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
3291-3301Informations de copyright
© 2022. Society of Surgical Oncology.
Références
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69:7–34.
doi: 10.3322/caac.21551
Yoon SS. The New American Joint Commission on cancer staging system for soft tissue sarcomas: splitting versus lumping. Ann Surg Oncol. 2018;25:1101–2.
doi: 10.1245/s10434-018-6419-4
Brennan MF, Antonescu CR, Moraco N, Singer S. Lessons learned from the study of 10,000 patients with soft tissue sarcoma. Ann Surg. 2014;260:416–21 (discussion 421-2).
doi: 10.1097/SLA.0000000000000869
Fletcher CD. The evolving classification of soft tissue tumours—an update based on the new 2013 WHO classification. Histopathology. 2014;64:2–11.
doi: 10.1111/his.12267
Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. New York: Springer International Publishing; 2017.
Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93–9.
doi: 10.3322/caac.21388
Fisher SB, Chiang YJ, Feig BW, et al. Comparative performance of the 7th and 8th editions of the American Joint Committee on Cancer Staging Systems for soft tissue sarcoma of the trunk and extremities. Ann Surg Oncol. 2018;25:1126–32.
doi: 10.1245/s10434-018-6378-9
Cates JMM. AJCC eighth edition for soft tissue sarcoma of the extremities and trunk. Ann Oncol. 2018;29:2023.
doi: 10.1093/annonc/mdy247
Cates JMM. The AJCC 8th edition staging system for soft tissue sarcoma of the extremities or trunk: a cohort study of the SEER database. J Natl Compr Cancer Netw. 2018;16:144–52.
doi: 10.6004/jnccn.2017.7042
Callegaro D, Miceli R, Bonvalot S, et al. Development and external validation of two nomograms to predict overall survival and occurrence of distant metastases in adults after surgical resection of localised soft-tissue sarcomas of the extremities: a retrospective analysis. Lancet Oncol. 2016;17:671–80.
doi: 10.1016/S1470-2045(16)00010-3
Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol. 2002;20:791–6.
doi: 10.1200/JCO.2002.20.3.791
Mariani L, Miceli R, Kattan MW, et al. Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer. 2005;103:402–8.
doi: 10.1002/cncr.20778
Callegaro D, Miceli R, Mariani L, Raut CP, Gronchi A. Soft tissue sarcoma nomograms and their incorporation into practice. Cancer. 2017;123:2802–20.
doi: 10.1002/cncr.30721
Tseng WW, Pasquali S, Hu JS, Menendez LR, Gronchi A. Staging systems and nomograms in soft tissue sarcoma: outcome prediction by categorization or personalization? Chin Clin Oncol. 2019;8:S12.
doi: 10.21037/cco.2019.01.05
Gamboa AC, Gronchi A, Cardona K. Soft-tissue sarcoma in adults: an update on the current state of histiotype-specific management in an era of personalized medicine. CA Cancer J Clin. 2020;70:200–29.
doi: 10.3322/caac.21605
Bagaria SP, Wagie AE, Gray RJ, et al. Validation of a soft tissue sarcoma nomogram using a National Cancer Registry. Ann Surg Oncol. 2015;22(Suppl 3):S398-403.
doi: 10.1245/s10434-015-4849-9
Eilber FC, Brennan MF, Eilber FR, Dry SM, Singer S, Kattan MW. Validation of the postoperative nomogram for 12-year sarcoma-specific mortality. Cancer. 2004;101:2270–5.
doi: 10.1002/cncr.20570
Eilber FC, Kattan MW. Sarcoma nomogram: validation and a model to evaluate impact of therapy. J Am Coll Surg. 2007;205:S90–5.
doi: 10.1016/j.jamcollsurg.2007.06.335
Trojani M, Contesso G, Coindre JM, et al. Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer. 1984;33:37–42.
doi: 10.1002/ijc.2910330108
Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.
doi: 10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4
Pasquali S, Colombo C, Pizzamiglio S, et al. High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial. Eur J Cancer. 2018;93:28–36.
doi: 10.1016/j.ejca.2018.01.071
Pasquali S, Pizzamiglio S, Touati N, et al. The impact of chemotherapy on survival of patients with extremity and trunk wall soft tissue sarcoma: revisiting the results of the EORTC-STBSG 62931 randomised trial. Eur J Cancer. 2019;109:51–60.
doi: 10.1016/j.ejca.2018.12.009
Vos M, Koseła-Paterczyk H, Rutkowski P, et al. Differences in recurrence and survival of extremity liposarcoma subtypes. Eur J Surg Oncol. 2018;44:1391–7.
doi: 10.1016/j.ejso.2018.03.028
Bartlett EK, Curtin CE, Seier K, et al. Histologic subtype defines the risk and kinetics of recurrence and death for primary extremity/truncal liposarcoma. Ann Surg. 2019;273:1189–96.
doi: 10.1097/SLA.0000000000003453
Crago AM, Dickson MA. Liposarcoma: multimodality management and future targeted therapies. Surg Oncol Clin N Am. 2016;25:761–73.
doi: 10.1016/j.soc.2016.05.007
Fiore M, Grosso F, Lo Vullo S, et al. Myxoid/round cell and pleomorphic liposarcomas: prognostic factors and survival in a series of patients treated at a single institution. Cancer. 2007;109:2522–31.
doi: 10.1002/cncr.22720
Trovik C, Bauer HCF, Styring E, et al. The Scandinavian Sarcoma Group Central Register: 6,000 patients after 25 years of monitoring of referral and treatment of extremity and trunk wall soft-tissue sarcoma. Acta Orthop. 2017;88:341–7.
doi: 10.1080/17453674.2017.1293441
Cahlon O, Brennan MF, Jia X, Qin LX, Singer S, Alektiar KM. A postoperative nomogram for local recurrence risk in extremity soft tissue sarcomas after limb-sparing surgery without adjuvant radiation. Ann Surg. 2012;255:343–7.
doi: 10.1097/SLA.0b013e3182367aa7
Gronchi A, Casali PG, Mariani L, et al. Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution. J Clin Oncol. 2005;23:96–104.
doi: 10.1200/JCO.2005.04.160
Gronchi A, Lo Vullo S, Colombo C, et al. Extremity soft tissue sarcoma in a series of patients treated at a single institution: local control directly impacts survival. Ann Surg. 2010;251:506–11.
doi: 10.1097/SLA.0b013e3181cf87fa
Callegaro D, Miceli R, Bonvalot S, et al. Development and external validation of a dynamic prognostic nomogram for primary extremity soft tissue sarcoma survivors. EClinicalMedicine. 2019;17:100215.
doi: 10.1016/j.eclinm.2019.11.008
Rueten-Budde AJ, van Praag VM, van de Sande MAJ, Fiocco M, PERSARC studygroup. Dynamic prediction of overall survival for patients with high-grade extremity soft tissue sarcoma. Surg Oncol. 2018;27:695–701.
doi: 10.1016/j.suronc.2018.09.003
Rueten-Budde AJ, van Praag VM, van de Sande MAJ, Fiocco M, PERSARC Study Group. External validation and adaptation of a dynamic prediction model for patients with high-grade extremity soft tissue sarcoma. J Surg Oncol. 2021;123:1050–6.
doi: 10.1002/jso.26337
Gundle KR, Kafchinski L, Gupta S, et al. Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. J Clin Oncol. 2018;36:704–9.
doi: 10.1200/JCO.2017.74.6941