CINSARC 在接受新辅助化疗的高危软组织肉瘤患者中的应用：来自 ISG-STS 1001 研究的结果。
CINSARC in high-risk soft tissue sarcoma patients treated with neoadjuvant chemotherapy: Results from the ISG-STS 1001 study.
机构信息
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.
Institut Claudius Régaud, Cancer Research Center of Toulouse (CRCT), IUCT- Oncopole, Toulouse, France.
出版信息
Cancer Med. 2023 Jan;12(2):1350-1357. doi: 10.1002/cam4.5015. Epub 2022 Jul 18.
BACKGROUND
The Complexity INdex in SARComas (CINSARC) is a transcriptional signature derived from the expression of 67 genes involved in mitosis control and chromosome integrity. This study aims to assess CINSARC value of in an independent series of high-risk patients with localized soft tissue sarcoma (STS) treated with preoperative chemotherapy within a prospective, randomized, phase III study (ISG-STS 1001).
PATIENTS AND METHODS
Patients with available pre-treatment samples, treated with 3 cycles of either standard (ST) preoperative or histotype-tailored (HT) chemotherapy, were scored according to CINSARC (low-risk, C1; high-risk, C2). The 10-year overall survival probability (pr-OS) according to SARCULATOR was calculated, and patients were classified accordingly (low-risk, Sarc-LR, 10-year pr-OS>60%; high-risk, Sarc-HR, 10-year pr-OS<60%). Survival functions were estimated using the Kaplan-Meier method and compared using log-rank test.
RESULTS
Eighty-six patients were included, 30 C1 and 56 C2, 49 Sarc-LR and 37 Sarc-HR. A low level of agreement between CINSARC and SARCULATOR was observed (Cohen's Kappa = 0.174). The 5-year relapse-free survival in C1 and C2 were 0.57 and 0.55 (p = 0.481); 5-year metastases-free survival 0.63 and 0.64 (p = 0.740); 5-year OS 0.80 and 0.72 (p = 0.460). The 5-year OS in C1 treated with ST and HT chemotherapy was 0.84 and 0.76 (p = 0.251) respectively; in C2 treated it was 0.72 and 0.70 (p = 0.349). The 5-year OS in Sarc-LR treated with S and HT chemotherapy was 0.80 and 0.82 (p = 0.502) respectively; in Sarc-HR it was 0.70 and 0.61 (p = 0.233).
CONCLUSIONS
Our results, although constrained by the small size of the series, suggest that CINSARC has weak prognostic power in high-risk, localized STS treated with neoadjuvant chemotherapy.
背景
肉瘤中的复杂性指数（CINSARC）是一个转录特征，源自参与有丝分裂控制和染色体完整性的 67 个基因的表达。本研究旨在评估 CINSARC 在一项前瞻性、随机、III 期研究（ISG-STS 1001）中接受术前化疗的局部软组织肉瘤（STS）高危患者的独立系列中的价值。
方法
对接受标准（ST）术前或组织类型定制（HT）化疗的 3 个周期治疗且有可用预处理样本的患者进行 CINSARC（低危，C1；高危，C2）评分。根据 SARCULATOR 计算 10 年总生存概率（pr-OS），并进行相应分类（低危，Sarc-LR，10 年 pr-OS>60%；高危，Sarc-HR，10 年 pr-OS<60%）。使用 Kaplan-Meier 法估计生存函数，并使用对数秩检验进行比较。
结果
共纳入 86 例患者，其中 C1 患者 30 例，C2 患者 56 例，Sarc-LR 患者 49 例，Sarc-HR 患者 37 例。CINSARC 和 SARCULATOR 之间的一致性水平较低（Cohen's Kappa = 0.174）。C1 和 C2 的 5 年无复发生存率分别为 0.57 和 0.55（p = 0.481）；5 年无转移生存分别为 0.63 和 0.64（p = 0.740）；5 年总生存分别为 0.80 和 0.72（p = 0.460）。C1 组接受 ST 和 HT 化疗的 5 年 OS 分别为 0.84 和 0.76（p = 0.251），C2 组分别为 0.72 和 0.70（p = 0.349）。Sarc-LR 组接受 ST 和 HT 化疗的 5 年 OS 分别为 0.80 和 0.82（p = 0.502），Sarc-HR 组分别为 0.70 和 0.61（p = 0.233）。
结论
尽管受系列规模较小的限制，但我们的结果表明，在接受新辅助化疗的局部高危 STS 患者中，CINSARC 的预后能力较弱。
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