Department of Surgery, Institut Curie, Paris University, Paris, France.
Department of Surgery, Sinai Health System, Toronto, Ontario, Canada.
Eur J Surg Oncol. 2021 Aug;47(8):2166-2172. doi: 10.1016/j.ejso.2021.02.024. Epub 2021 Feb 26.
Locally advanced soft tissue sarcoma (STS) management may include neoadjuvant or adjuvant treatment by radiotherapy (RT), chemotherapy (CT) or chemoradiotherapy (CRT) followed by wide surgical excision. While pathological complete response (pCR) to preoperative treatment is prognostic for survival in osteosarcomas, its significance for STS is unclear. We aimed to evaluate the prognostic significance of pCR to pre-operative treatment on 3-year disease-free survival (3y-DFS) in STS patients.
This is an observational, retrospective, international, study of adult patients with primary non-metastatic STS of the extremities and trunk wall, any grade, diagnosed between 2008 and 2012, treated with at least neoadjuvant treatment and surgical resection and observed for a minimum of 3 years after diagnosis. The primary objective was to evaluate the effect of pCR. (≤5% viable tumor cells or ≥95% necrosis/fibrosis) on 3y-DFS. Effect on local recurrence-free survival (LRFS), distant recurrence-free survival (MFS) overall survival (OS) at 3 years was also analyzed. Statistical univariate analysis utilized chi-square independence test and odds ratio confidence interval (CI) estimate, multivariate analysis was performed using LASSO.
A total of 330 patients (median age 56 years old, range:19-95) treated by preoperative RT (67%), CT (15%) or CRT (18%) followed by surgery were included. pCR was achieved in 74/330 (22%) of patients, of which 56/74 (76%) had received RT. 3-yr DFS was observed in 76% of patients with pCR vs 61% without pCR (p < 0.001). Multivariate analysis showed that pCR is statistically associated with better MFS (95% CI, 1.054-3.417; p = 0.033), LRFS (95% CI, 1.226-5.916; p = 0.014), DFS (95% CI, 1.165-4.040; p = 0.015) and OS at 3 years (95% CI, 1.072-5.210; p = 0.033).
In a wide, heterogeneous STS population we showed that pCR to preoperative treatment is prognostic for survival.
局部晚期软组织肉瘤（STS）的治疗可能包括新辅助或辅助放疗（RT）、化疗（CT）或放化疗（CRT），然后进行广泛的手术切除。虽然骨肉瘤患者术前治疗的病理完全缓解（pCR）与生存有关，但对于 STS 来说，其意义尚不清楚。我们旨在评估 STS 患者术前治疗的 pCR 对 3 年无病生存（3y-DFS）的预后意义。
这是一项观察性、回顾性、国际性研究，纳入了 2008 年至 2012 年间诊断为四肢和躯干壁原发性非转移性、任何分级的成人 STS 患者，至少接受新辅助治疗和手术切除，并在诊断后至少 3 年进行观察。主要目的是评估 pCR（≤5%存活肿瘤细胞或≥95%坏死/纤维化）对 3y-DFS 的影响。还分析了局部无复发生存率（LRFS）、远处无复发生存率（MFS）和 3 年总生存率（OS）的影响。统计单因素分析采用卡方独立性检验和优势比置信区间（CI）估计，多因素分析采用 LASSO。
共纳入 330 例（中位年龄 56 岁，范围 19-95 岁）接受术前 RT（67%）、CT（15%）或 CRT（18%）治疗后行手术的患者。330 例患者中，74 例（22%）达到 pCR，其中 56 例（76%）接受了 RT。76%的 pCR 患者 3 年 DFS 观察率优于无 pCR 患者（61%）（p<0.001）。多因素分析显示，pCR 与更好的 MFS（95%CI，1.054-3.417；p=0.033）、LRFS（95%CI，1.226-5.916；p=0.014）、DFS（95%CI，1.165-4.040；p=0.015）和 3 年 OS（95%CI，1.072-5.210；p=0.033）相关。
在广泛的 STS 人群中，我们发现术前治疗的 pCR 与生存有关。
