Seldon Crystal, Shrivastava Gautam, Fernandez Melanie, Jarboe John, Conway Sheila, Pretell Juan, Freedman Laura, Wolfson Aaron, Zhao Wei, Kwon Deukwoo, Rosenberg Andrew, Subhawong Ty, Trent Jonathan, Yechieli Raphael
Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA.
Department of Orthopedic Surgery, University of Miami, Miami, FL 33136, USA.
Cancers (Basel). 2021 Mar 3;13(5):1074. doi: 10.3390/cancers13051074.
(1) Background: Pathologic necrosis of soft tissue sarcomas (STS) has been used to determine treatment response, but its relationship to neoadjuvant treatments remains indeterminate. In this retrospective, single institution study, we hypothesized that neoadjuvant chemoradiation (NA-CRT) yields higher rates of pathologic complete response (pCR) than neoadjuvant radiation (NA-XRT) or chemotherapy (NA-CT) alone. (2) Methods: Patients with extremity STS between 2011-2020 who received neoadjuvant treatment were included. pCR was defined as percent necrosis of the surgical specimen greater than or equal to 90%. (3) Results: 79 patients were analyzed. 51.9% of the population were male with a mean age of 58.4 years. 49.4% identified as Non-Hispanic White. Twenty-six (32.9%) patients achieved pCR while 53 (67.1%) did not. NA-CT (OR 15.82, 95% CI = 2.58-96.9, = 0.003 in univariate (UVA) and OR 24.7, 95% CI = 2.88-211.2, = 0.003 in multivariate (MVA), respectively) and NA-XRT (OR 5.73, 95% CI = 1.51-21.8, = 0.010 in UVA and OR 7.95, 95% CI = 1.87-33.7, = 0.005 in MVA, respectively) was significantly associated with non- pCR when compared to NA-CRT. The analysis also demonstrated that grade 3 tumors, when using grade 2 as reference, also had significantly higher odds of achieving pCR (OR 0.23, 95% CI = 0.06-0.80, = 0.022 in UVA and OR 0.16, 95% CI = 0.04-0.70, = 0.015 in MVA, respectively). (4) Conclusion: NA-CRT yields superior pCR compared to other neoadjuvant regimens. This extends to higher grade tumors.
（1）背景：软组织肉瘤（STS）的病理坏死已被用于确定治疗反应，但其与新辅助治疗的关系仍不明确。在这项回顾性单机构研究中，我们假设新辅助放化疗（NA-CRT）比单纯新辅助放疗（NA-XRT）或化疗（NA-CT）产生更高的病理完全缓解（pCR）率。（2）方法：纳入2011年至2020年间接受新辅助治疗的四肢STS患者。pCR定义为手术标本坏死百分比大于或等于90%。（3）结果：分析了79例患者。51.9%的患者为男性，平均年龄58.4岁。49.4%为非西班牙裔白人。26例（32.9%）患者达到pCR，53例（67.1%）未达到。与NA-CRT相比，NA-CT（单因素分析（UVA）中OR为15.82，95%CI = 2.58 - 96.9，P = 0.003；多因素分析（MVA）中OR为24.7，95%CI = 2.88 - 211.2，P = 0.003）和NA-XRT（UVA中OR为5.73，95%CI = 1.51 - 21.8，P = 0.010；MVA中OR为7.95，95%CI = 1.87 - 33.7，P = 0.005）与非pCR显著相关。分析还表明，以2级肿瘤为参照，3级肿瘤达到pCR的几率也显著更高（UVA中OR为0.23，95%CI = 0.06 - 0.80，P = 0.022；MVA中OR为0.16，95%CI = 0.04 - 0.70，P = 0.015）。（4）结论：与其他新辅助治疗方案相比，NA-CRT产生更高的pCR率。这一结论也适用于更高分级的肿瘤。
