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

Abstract

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 diseasefree and overall survival (DFS, OS) and crude-cumulativeincidence (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.

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“…Several ongoing trials are currently, however, still investigating the exact role of chemotherapy in retroperitoneal STS [34]. As retroperitoneal MPNSTs have one of the highest risks for local and distant recurrence and early death, the additional value of multimodal treatment is especially of interest in these patients [35,36].…”

Development and Validation of an Individualized Nomogram for Predicting Survival in Patients with Esophageal Carcinoma after Resection

“…Clinical nomogram has been developed with intuitive graphs to quantify risk by incorporating all known prognostic factors for individual patient [9]. Nomogram has been widely used in different cancer types, and shown to be more accurate than the TNM staging systems for predicting prognosis [10][11][12].…”

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

“…Furthermore, the results of the current study suggested that well-selected patients who undergo radical surgical resections of LRs have a reasonable likelihood of durable survival 3,16,17. When compared with our previous report analyzing outcomes after a first recurrence of RPS,15 the median…”