Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2022 May;29(5):3291-3301. doi: 10.1245/s10434-021-11205-5. Epub 2022 Jan 11.
Prognostic nomograms for patients with resected extremity soft tissue sarcoma (STS) include the Sarculator and Memorial Sloan Kettering (MSKCC) nomograms. We sought to validate these two nomograms within a large, modern, multi-institutional cohort of resected primary extremity STS patients.
Resected primary extremity STS patients from 2000 to 2017 were identified across nine high-volume U.S. institutions. Predicted 5- and 10-year overall survival (OS) and distant metastases cumulative incidence (DMCI), and 4-, 8-, and 12-year disease-specific survival (DSS) were calculated with Sarculator and MSKCC nomograms, respectively. Predicted survival probabilities stratified in quintiles were compared in calibration plots to observed survival assessed by Kaplan-Meier estimates. Cumulative incidence was estimated for DMCI. Harrell's concordance index (C-index) assessed discriminative ability of nomograms.
A total of 1326 patients underwent resection of primary extremity STS. Common histologies included: undifferentiated pleomorphic sarcoma (35%), fibrosarcoma (13%), and leiomyosarcoma (9%). Median tumor size was 8.0 cm (IQR 4.5-13.0). Tumor grade distribution was: Grade 1 (13%), Grade 2 (9%), Grade 3 (78%). Median OS was 172 months, with estimated 5- and 10-year OS of 70% and 58%. C-indices for 5- and 10-year OS (Sarculator) were 0.72 (95% CI 0.70-0.75) and 0.73 (95% CI 0.70-0.75), and 0.72 (95% CI 0.69-0.75) for 5- and 10-year DMCI. C-indices for 4-, 8-, and 12-year DSS (MSKCC) were 0.71 (95% CI 0.68-0.75). Calibration plots showed good prognostication across all outcomes.
Sarculator and MSKCC nomograms demonstrated good prognostic ability for survival and recurrence outcomes in a modern, multi-institutional validation cohort of resected primary extremity STS patients. External validation of these nomograms supports their ongoing incorporation into clinical practice.
用于切除肢体软组织肉瘤（STS）患者的预后列线图包括 Sarculator 和 Memorial Sloan Kettering（MSKCC）列线图。我们试图在切除肢体原发性 STS 患者的大型现代多机构队列中验证这两个列线图。
从 2000 年至 2017 年，在美国 9 家高容量机构中确定了切除肢体原发性 STS 患者。使用 Sarculator 和 MSKCC 列线图分别计算了预测的 5 年和 10 年总生存率（OS）和远处转移累积发生率（DMCI），以及预测的 4 年、8 年和 12 年疾病特异性生存率（DSS）。在校准图中，将预测的生存率概率分层五分位数与 Kaplan-Meier 估计的观察生存率进行比较。使用 Harrell 一致性指数（C 指数）评估了列线图的判别能力。
共 1326 例患者接受了原发性肢体 STS 的切除术。常见的组织学类型包括：未分化多形性肉瘤（35%），纤维肉瘤（13%）和平滑肌肉瘤（9%）。肿瘤大小中位数为 8.0cm（IQR 4.5-13.0）。肿瘤分级分布为：1 级（13%），2 级（9%），3 级（78%）。中位 OS 为 172 个月，估计 5 年和 10 年 OS 分别为 70%和 58%。Sarculator 预测的 5 年和 10 年 OS 的 C 指数分别为 0.72（95%CI 0.70-0.75）和 0.73（95%CI 0.70-0.75），以及 5 年和 10 年 DMCI 的 C 指数为 0.72（95%CI 0.69-0.75）。MSKCC 预测的 4 年、8 年和 12 年 DSS 的 C 指数分别为 0.71（95%CI 0.68-0.75）。校准图显示，所有结局的预后均良好。
Sarculator 和 MSKCC 列线图在切除肢体原发性 STS 患者的现代多机构验证队列中显示出良好的生存和复发结局的预测能力。这些列线图的外部验证支持将其纳入临床实践。
