Patterns of recurrence and survival probability after second recurrence of retroperitoneal sarcoma: A study from TARPSWG

Houdt, Winan J. van; Fiore, Marco; Barretta, Francesco; Rutkowski, Piotr; Blay, Jean‐Yves; Lahat, Guy; Strauß, D.; Gonzalez, Ricardo J.; Ahuja, Nita; Grignani, Giovanni; Quagliuolo, Vittorio; Stoeckle, Eberhard; Paoli, Antonino De; Schrage, Yvonne; Cardona, Kenneth; Pennacchioli, Elisabetta; Pillarisetty, Venu G.; Nessim, Carolyn; Swallow, Carol J.; Bagaria, Sanjay P.; Canter, Robert J.; Mullen, John; Callegaro, Dario; Fairweather, Mark; Miceli, Rosalba; Raut, Chandrajit P.; Gronchi, Alessandro; Gladdy, Rebecca A.

doi:10.1002/cncr.33139

Cited by 25 publications

(17 citation statements)

References 18 publications

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“…62.5% of distant relapses was in the lung followed by nodes (18.8%) and liver (12.5%). These patterns of relapse have been reported in studies ( 24 , 25 ). Similarly, in the developmental Italian cohort, recurrence patterns were specific to histological subtype with liposarcoma having the highest 6-year crude-cumulative incidence (CCI) of second local recurrence at 60.2% to 70.9% while LMS had a higher 6-year CCI of distant metastasis at 36.3% ( 16 ).…”

Section: Discussionsupporting

confidence: 84%

Characteristics and Outcomes of Locally Recurrent Retroperitoneal Sarcoma After First Relapse in a Single Tertiary Asian Centre and Applicability of the Sarculator

et al. 2021

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ObjectiveRetroperitoneal sarcomas (RPS) comprise of 15% of soft tissue sarcomas where five-year overall survival rate is about 50%. Locoregional recurrences are observed in up to 50% of patients within the first five years following resection. Various factors have been shown to influence survival outcomes, such as histological subtype and tumour size. A nomogram for first relapse locally recurrent RPS was developed using 602 patients from 22 centres. The recurrent RPS Sarculator is available in an electronic interface and includes variables of age, size, margins of re-resection, radiotherapy, chemotherapy and histology to predict for 6-year disease-free survival (DFS) and overall survival (OS). It has not been validated externally. This study aims to validate the Sarculator recurrence nomogram in predicting the survival outcomes of recurrent RPS in an Asian population as well as examine relapse patterns.MethodsPatients diagnosed with first recurrent RPS from 1 January 2000 to 31 December 2017 with first local relapse and eligible for curative re-resection were retrospectively analysed. The type of surgery was unique for individual patients and suggestions of adjuvant therapy were based on globally recognised standards. Patients were followed up every 3 to 4 months post-operatively for the first 2 to 3 years and 6-monthly to a year thereafter. A R0 or R1 margin is deemed as complete resection, including a microscopically negative margin (R0) and microscopically positive but macroscopically clear margin (R1). R2 is classified as an incomplete resection with tumour rupture or remaining disease. Harrell’s C concordance index was used to determine the nomogram’s discriminative ability and calibration plots were used to assess accuracy. For the calibration, the patients were divided into 3 groups. Death data was retrieved from the National Birth and Death registry for accuracy.ResultsThere were 53 patients included in this study. Patient and tumour characteristics have been summarised in Table 1. All patients had their second resection at a single centre. 66.0% had their first resection at the same centre. The median age was 53 (range 21- 79) at diagnosis, median tumour size was 17cm (12cm to 28cm) and median follow-up duration was 44.1 months. The most commonly encountered subtypes were de-differentiated liposarcoma (DDLPS) (56.6%), well-differentiated liposarcoma (WDLPS) (20.8%) and leiomyosarcoma (LMS) (11.3%) with a majority being high-grade (75.5%). The median disease-free interval was 2.9 years (2- 5.3 years) from the first surgery. The median age at second surgery was 56 (21- 79) and all patients had a complete resection (R0/R1). Recurrence patterns differed with subtypes where 90.9% and 9.1% of WDLS, 76.7% and 16.7% of DDLPS and 83.3% and 16.7% of LMS had local and distant relapses respectively from the second surgery. 62.5% of distant relapses was in the lung followed by nodes (18.8%) and liver (12.5%). The 5-year OS from the second surgery was 66.2% (95% CI: 54.3%- 80.8%). The 1-year, 3 years and 6 years DFS were 50.2% (95% CI: 38.2% - 65.9%), 10.4% (4.26% - 25.5%) and 3.91% (0.684% - 22.4%) respectively. Overall, 32 patients (60.4%) had passed away from sarcoma. The concordance indices for 6-year OS and DFS were 0.7 and 0.65 (Figure 1) respectively which represents a fairly accurate prediction by Sarculator.ConclusionOur study has shown the Sarculator nomogram for primary recurrent was applicable in our cohort and its potential application in an Asian setting. The Sarculator nomogram will be a useful tool in clinical practice to improve risk stratification and facilitate prognosis-based decision-making. Moving forward, novel therapeutic strategies are required to enhance the prognosis of patients with recurrent RPS.

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Section: Discussionsupporting

confidence: 84%

Characteristics and Outcomes of Locally Recurrent Retroperitoneal Sarcoma After First Relapse in a Single Tertiary Asian Centre and Applicability of the Sarculator

et al. 2021

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“…This is very unlikely and is in direct contradiction to the main studies, which reported twice as many local relapses after mCR in the surgery group compared with the preoperative‐RT group (47 vs 23 relapses). Compliance to RT might have a long‐term impact on local control, and this could only be assessed by following these patients longer. Indeed, long‐term recurrences are common in this setting 11‐13 Leaving out a part of the tumor (eg, mostly well differentiated part) might not affect local control, especially for cases in which the nondelineated part could be resected during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, long-term recurrences are common in this setting. [11][12][13] • Leaving out a part of the tumor (eg, mostly well differentiated part) might not affect local control, especially for cases in which the nondelineated part could be resected during surgery. This would have a major impact on the analysis because incorrect target delineation was the most common reason for unacceptable overall RT compliance, of which 64% was caused by gross tumor volume miss.…”

Section: Discussionmentioning

confidence: 99%

Critical impact of radiotherapy protocol compliance and quality in the treatment of retroperitoneal sarcomas: Results from the EORTC 62092‐22092 STRASS trial

Haas

Stelmes

Clementel

et al. 2022

Cancer

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BACKGROUND:The European Organization for Research and Treatment of Cancer 22092-62092 STRASS trial failed to demonstrate the superiority of neoadjuvant radiotherapy (RT) over surgery alone in patients with retroperitoneal sarcoma. Therefore, an RT qualityassurance program was added to the study protocol to detect and correct RT deviations. The authors report results from the trial RT quality-assurance program and its potential effect on patient outcomes. METHODS: To evaluate the effect of RT compliance on survival outcomes, a composite end point was created. It combined the information related to planning target volume coverage, target delineation, total dose received, and overall treatment time into 2 groups: non-RT-compliant (NRC) for patients who had unacceptable deviation(s) in any of the previous categories and RT-compliant (RC) otherwise. Abdominal recurrence-free survival (ARFS) and overall survival were compared between the 2 groups using a Cox proportional hazard model adjusted for known prognostic factors. RESULTS: Thirty-six of 125 patients (28.8%) were classified as NRC, and the remaining 89 patients (71.2%) were classified as RC. The 3-year ARFS rate was 66.8% (95% confidence interval [CI], 55.8%-75.7%) and 49.8% (95% CI, 32.7%-64.8%) for the RC and NRC groups, respectively (adjusted hazard ratio, 2.32; 95% CI, 1.25-4.32; P = .008). Local recurrence after macroscopic complete resection occurred in 13 of 89 patients (14.6%) versus 2 of 36 patients (5.6%) in the RC and NRC groups, respectively. CONCLUSIONS: The current analysis suggests a significant benefit in terms of ARFS in favor of the RC group. This association did not translate into less local relapses after complete resection in the RC group. Multidisciplinary collaboration and review of cases are critical to avoid geographic misses, especially for rare tumors like retroperitoneal sarcoma.

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“…Because of metastasis, multifocal disease, and multiple organ resection are usually contraindications to surgery, the potential bene cial effects of surgery are not always obvious, which lead decision-making very complicated. Because of metastasis, multifocal tumor, and multiple organ resection are usually contraindications to surgery [14]. And it is extremely di cult for clinical decision-making whether or not patients with recurrence should undergo surgery.…”

Section: Discussionmentioning

confidence: 99%

Nomogram predicting overall survival after surgical resection for retroperitoneal leiomyosarcoma patients

Zhuang

Zhang

Fang

et al. 2022

Preprint

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Aim: To develop a survival nomogram for patients with retroperitoneal leiomyosarcoma (RLMS) after surgery. Methods: 118 patients with RLMS after surgical resection at the General Surgery Department, Shanghai Public Health Clinical Center, Fudan University were retrospectively analyzed. The nomogram was constructed based on COX regression model and discrimination was assessed using the concordance index (c-index). The predicted and actual survival was evaluated through calibration plots. Results: The c-index of the nomogram was 0.779 (95% CI, 0.659-0.898). The predicted and actual survival probabilities are in good agreement in all calibration curve.Conclusion: This study built the first survival nomogram for patients with surgical resected RLMS.

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Patterns of recurrence and survival probability after second recurrence of retroperitoneal sarcoma: A study from TARPSWG

Cited by 25 publications

References 18 publications

Characteristics and Outcomes of Locally Recurrent Retroperitoneal Sarcoma After First Relapse in a Single Tertiary Asian Centre and Applicability of the Sarculator

Characteristics and Outcomes of Locally Recurrent Retroperitoneal Sarcoma After First Relapse in a Single Tertiary Asian Centre and Applicability of the Sarculator

Critical impact of radiotherapy protocol compliance and quality in the treatment of retroperitoneal sarcomas: Results from the EORTC 62092‐22092 STRASS trial

Nomogram predicting overall survival after surgical resection for retroperitoneal leiomyosarcoma patients

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