High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial.

Sandro Pasquali, Chiara Colombo, Sara Pizzamiglio, Paolo Verderio, Dario Callegaro, Silvia Stacchiotti, Javier Martin Broto, Antonio Lopez-Pousa, Stefano Ferrari, Andres Poveda, Antonino De Paoli, Vittorio Quagliuolo, Josefina Cruz Jurado, Alessandro Comandone, Giovanni Grignani, Rita De Sanctis, Elena Palassini, Antonio Llomboart-Bosch, Angelo Paolo Dei Tos, Paolo G CasaliPiero Picci, Alessandro Gronchi

Research output: Contribution to journalArticle

Abstract

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. 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. 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. 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. European Union Drug Regulating Authorities Clinical Trials No. 2004-003979-36.
Original languageUndefined/Unknown
Pages (from-to)28-36
Number of pages9
JournalEuropean Journal of Cancer
Volume93
DOIs
Publication statusPublished - Apr 1 2018

Keywords

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols, therapeutic use
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nomograms
  • Outcome Assessment (Health Care)
  • Perioperative Care
  • Prognosis
  • Sarcoma, classification, drug therapy, pathology
  • Survival Rate
  • Young Adult
  • Chemotherapy
  • Choi criteria
  • Neoadjuvant
  • Soft tissue sarcoma
  • Tumour response

Cite this

High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial. / Pasquali, Sandro; Colombo, Chiara; Pizzamiglio, Sara; Verderio, Paolo; Callegaro, Dario; Stacchiotti, Silvia; Martin Broto, Javier; Lopez-Pousa, Antonio; Ferrari, Stefano; Poveda, Andres; De Paoli, Antonino; Quagliuolo, Vittorio; Jurado, Josefina Cruz; Comandone, Alessandro; Grignani, Giovanni; De Sanctis, Rita; Palassini, Elena; Llomboart-Bosch, Antonio; Dei Tos, Angelo Paolo; Casali, Paolo G; Picci, Piero; Gronchi, Alessandro.

In: European Journal of Cancer, Vol. 93, 01.04.2018, p. 28-36.

Research output: Contribution to journalArticle

Pasquali, S, Colombo, C, Pizzamiglio, S, Verderio, P, Callegaro, D, Stacchiotti, S, Martin Broto, J, 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 2018, 'High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial.', European Journal of Cancer, vol. 93, pp. 28-36. https://doi.org/10.1016/j.ejca.2018.01.071
Pasquali, Sandro ; Colombo, Chiara ; Pizzamiglio, Sara ; Verderio, Paolo ; Callegaro, Dario ; Stacchiotti, Silvia ; Martin Broto, Javier ; Lopez-Pousa, Antonio ; Ferrari, Stefano ; Poveda, Andres ; De Paoli, Antonino ; Quagliuolo, Vittorio ; Jurado, Josefina Cruz ; Comandone, Alessandro ; Grignani, Giovanni ; De Sanctis, Rita ; Palassini, Elena ; Llomboart-Bosch, Antonio ; Dei Tos, Angelo Paolo ; Casali, Paolo G ; Picci, Piero ; Gronchi, Alessandro. / High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial. In: European Journal of Cancer. 2018 ; Vol. 93. pp. 28-36.
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abstract = "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. 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. 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. 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. European Union Drug Regulating Authorities Clinical Trials No. 2004-003979-36.",
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TY - JOUR

T1 - High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial.

AU - Pasquali, Sandro

AU - Colombo, Chiara

AU - Pizzamiglio, Sara

AU - Verderio, Paolo

AU - Callegaro, Dario

AU - Stacchiotti, Silvia

AU - Martin Broto, Javier

AU - Lopez-Pousa, Antonio

AU - Ferrari, Stefano

AU - Poveda, Andres

AU - De Paoli, Antonino

AU - Quagliuolo, Vittorio

AU - Jurado, Josefina Cruz

AU - Comandone, Alessandro

AU - Grignani, Giovanni

AU - De Sanctis, Rita

AU - Palassini, Elena

AU - Llomboart-Bosch, Antonio

AU - Dei Tos, Angelo Paolo

AU - Casali, Paolo G

AU - Picci, Piero

AU - Gronchi, Alessandro

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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. 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. 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. 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. European Union Drug Regulating Authorities Clinical Trials No. 2004-003979-36.

AB - 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. 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. 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. 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. European Union Drug Regulating Authorities Clinical Trials No. 2004-003979-36.

KW - Adolescent

KW - Adult

KW - Aged

KW - Antineoplastic Combined Chemotherapy Protocols, therapeutic use

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Nomograms

KW - Outcome Assessment (Health Care)

KW - Perioperative Care

KW - Prognosis

KW - Sarcoma, classification, drug therapy, pathology

KW - Survival Rate

KW - Young Adult

KW - Chemotherapy

KW - Choi criteria

KW - Neoadjuvant

KW - Soft tissue sarcoma

KW - Tumour response

U2 - 10.1016/j.ejca.2018.01.071

DO - 10.1016/j.ejca.2018.01.071

M3 - Articolo

VL - 93

SP - 28

EP - 36

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

ER -