应用肉瘤列线图评估原发性高级别腹膜后肉瘤的新辅助治疗和组织病理学反应。

Evaluation of neoadjuvant therapy and histopathologic response in primary, high-grade retroperitoneal sarcomas using the sarcoma nomogram.

机构信息

Department of Surgery, Division of Surgical Oncology, University of California at Los Angeles, Los Angeles, California 90095-1782, USA.

出版信息

Cancer. 2010 Aug 15;116(16):3883-91. doi: 10.1002/cncr.25271.

DOI:10.1002/cncr.25271

PMID:20564145

Abstract

BACKGROUND

Patients with primary high-grade retroperitoneal soft tissue sarcomas have a 5-year disease-specific survival (DSS) of <40%. The impact of neoadjuvant therapy on histopathologic response and DSS are unknown.

METHODS

From 1987 to 2007, 55 patients with primary high-grade retroperitoneal sarcoma received neoadjuvant therapy. All patients underwent surgical resection, and response was assessed histopathologically. Patients with >or=95% pathologic necrosis were classified as responders. Clinicopathologic variables were analyzed for association with DSS. Observed DSS was then compared with the Memorial Sloan-Kettering Cancer Center Sarcoma Nomogram predicted DSS.

RESULTS

The median tumor size was 15 cm, and the median follow-up time for survivors was 68 months. The 5-year DSS for all 55 patients was 47% and did not significantly differ from the 37% predicted by the sarcoma nomogram for such patients (P=.44). Fourteen (25%) of the patients had >or=95% pathologic necrosis and were defined as responders; 41 (75%) were nonresponders. The 5-year DSS for responders was 83%. This was significantly better than the 5-year DSS of 34% for nonresponders (P=.002) and the 39% predicted by the sarcoma nomogram for responders (P=.018). The 34% 5-year DSS for nonresponders did not significantly differ from the 35% predicted by the sarcoma nomogram (P=.51).

CONCLUSIONS

Neoadjuvant therapy was not associated with an overall improvement in DSS in patients with primary high-grade retroperitoneal sarcoma compared with the sarcoma nomogram prediction. Histopathologic response to neoadjuvant therapy was associated with a significantly improved DSS compared with nonresponders and with the sarcoma nomogram prediction for such patients.

摘要

背景

原发性高级腹膜后软组织肉瘤患者的 5 年疾病特异性生存率（DSS）<40%。新辅助治疗对组织病理学反应和 DSS 的影响尚不清楚。

方法

1987 年至 2007 年，55 例原发性高级腹膜后肉瘤患者接受新辅助治疗。所有患者均接受手术切除，并进行组织病理学评估。将>或=95%的病理坏死患者归类为应答者。分析临床病理变量与 DSS 的关系。观察到的 DSS 然后与 Memorial Sloan-Kettering 癌症中心肉瘤预测计预测的 DSS 进行比较。

结果

中位肿瘤大小为 15cm，幸存者的中位随访时间为 68 个月。55 例患者的 5 年 DSS 为 47%，与此类患者肉瘤预测计预测的 37%无显著差异（P=.44）。14 例（25%）患者的病理坏死>或=95%，定义为应答者；41 例（75%）为无应答者。应答者的 5 年 DSS 为 83%。这明显优于无应答者的 5 年 DSS（34%）（P=.002）和应答者的肉瘤预测计预测的 39%（P=.018）。无应答者的 5 年 DSS 为 34%，与肉瘤预测计预测的 35%无显著差异（P=.51）。