Predicting Survival in Patients Undergoing Resection for Locally Recurrent Retroperitoneal Sarcoma: A Study and Novel Nomogram from TARPSWG

Chandrajit P Raut, Dario Callegaro, Rosalba Miceli, Francesco Barretta, Piotr Rutkowski, Jean-Yves Blay, Guy Lahat, Dirk C Strauss, Ricardo Gonzalez, Nita Ahuja, Giovanni Grignani, Vittorio Quagliuolo, Eberhard Stoeckle, Antonino De Paoli, Venu G Pillarisetty, Carolyn Nessim, Carol J Swallow, Sanjay Bagaria, Robert Canter, John MullenHans J Gelderblom, Elisabetta Pennacchioli, Frits van Coevorden, Kenneth Cardona, Marco Fiore, Mark Fairweather, Alessandro Gronchi

Research output: Contribution to journalArticlepeer-review


PURPOSE: The role of surgery for first relapse locally recurrent retroperitoneal sarcoma (RPS-LR1) is uncertain. We report outcomes of the largest RPS-LR1 series and propose a new prognostic nomogram. EXPERIMENTAL DESIGN: Patients with consecutive RPS-LR1 without distant metastases who underwent resection at 22 centers (2002-2011) were included. Endpoints were disease-free and overall survival (DFS, OS) and crude-cumulative-incidence (CCI) of local/distant recurrence from second surgery. Nomograms predicting DFS and OS from second surgery were developed and validated (calibration plots); discrimination was assessed (Harrell C index). RESULTS: Of 684 patients identified, full prognostic variable data were available for 602. Initial surgery for primary RPS was performed at our institutions in 188 patients (31%) and elsewhere in 414 (69%). At a median follow-up of 119 months [Interquartile range (IQR), 80-169] from initial surgery and 75 months (IQR 50-105) from second surgery, 6-year DFS and OS were 19.2% [95% confidence interval (CI), 16.0-23.0%] and 54.1% (95% CI, 49.8-58.8%), respectively. Recurrence patterns and survival probability were histology-specific, with liposarcoma subtypes having the highest 6-year CCI of second local recurrence (LR, 60.2%-70.9%) and leiomyosarcoma (LMS) having higher 6-year CCI of distant metastasis (DM, 36.3%). Nomograms included age at second surgery, multifocality, grade, completeness of second surgery, histology, chemotherapy/radiotherapy at first surgery, and number of organs resected at first surgery. OS and DFS nomograms showed good calibration and discriminative ability (C index 0.70 and 0.67, respectively). CONCLUSIONS: We developed nomograms to predict DFS and OS for patients undergoing RPS-LR1 resection. Nomograms provide individualized, disease-relevant estimations of survival for RPS-LR1 patients and assist in clinical decisions.
Original languageEnglish
Pages (from-to)2664-2671
Number of pages8
JournalClin. Cancer Res.
Issue number8
Publication statusPublished - Apr 15 2019


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