Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Pathology, Complejo Hospitalario Metropolitano CSS, Panama, Panama.
Eur J Surg Oncol. 2021 Jul;47(7):1778-1783. doi: 10.1016/j.ejso.2021.02.009. Epub 2021 Feb 16.
The aim is to evaluate which of the existing scoring systems of histological response to neoadjuvant chemotherapy best stratifies the clinical outcome of patients with localized Ewing sarcoma of bone.
474 patients with diagnosis of localized Ewing sarcoma of bone were included. The median follow-up was 13.5 years.
The overall survival and the disease-free survival (DFS) were 70.8% and 63.9% at 5 years. The percentage of histological response to neoadjuvant chemotherapy ranged between 5% and 100% (mean 83%). The agreement between Bologna System and the different percentual cut-offs of histological response to neoadjuvant chemotherapy was high, with kappa statistics of 0.83 for a cut-off of ≥90%; 0.86 for a cut-off of ≥95%; 0.79 for a cut-off of ≥96% and 0.61 for a cut-off of 100%. Statistically higher DFS rates for good responders compared to poor responders were found when using each given system. Model performance indicators showed that Bologna system had a lower AIC score and a higher c-statistics to predict DFS. When the patients classified as good responders using the different percentual cut-offs of histological response to neoadjuvant chemotherapy, were instead re-classified using the Bologna system, statistical differences were noted in DFS within each specific group.
All scoring tools to evaluate histological response to neoadjuvant chemotherapy offer good predictive value for DFS in localized Ewing's sarcoma of bone. The Bologna system better stratifies those patients with histological response to neoadjuvant chemotherapy between 90 and 99%, representing a more reliable scoring tool in this subset.
评估现有的新辅助化疗组织学反应评分系统中，哪一种能最好地分层局部骨尤文肉瘤患者的临床结局。
纳入 474 例局部骨尤文肉瘤患者。中位随访时间为 13.5 年。
5 年时总生存率和无病生存率（DFS）分别为 70.8%和 63.9%。新辅助化疗的组织学反应率在 5%至 100%之间（平均 83%）。博洛尼亚系统与不同百分比新辅助化疗组织学反应的分类之间具有较高的一致性，kappa 统计量为≥90%的截定点为 0.83；≥95%的截定点为 0.86；≥96%的截定点为 0.79；100%的截定点为 0.61。使用每个系统时，发现良好反应者的 DFS 率明显高于不良反应者。模型性能指标表明，博洛尼亚系统的 AIC 评分较低，c 统计量较高，可预测 DFS。当使用不同百分比的新辅助化疗组织学反应分类将患者分为良好反应者时，改用博洛尼亚系统进行重新分类，在每个特定组中DFS 均存在统计学差异。
所有评估新辅助化疗组织学反应的评分工具都能很好地预测局部尤文肉瘤的DFS。博洛尼亚系统在 90%至 99%的组织学反应患者中能更好地分层，在该亚组中是一种更可靠的评分工具。
