van der Burg Stijn J C, Fiore Marco, Rutkowski Piotr, Albertsmeier Markus, Bonvalot Sylvie, Grignol Valerie P, Raut Chandrajit P, Cananzi Ferdinando C M, Mullinax John E, Gyorki David E, Pennacchioli Elisabetta, Ford Samuel J, Nessim Carolyn, Cardona Kenneth, Callegaro Dario, Skoczylas Jacek, Lindner Lars H, Gronchi Alessandro, Van Houdt Winan J
Department of Surgery, Antoni van Leeuwenhoek Hospital (NKI-AVL), Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Ann Surg Oncol. 2025 May 15. doi: 10.1245/s10434-025-17306-9.
Comsplete resection is the primary treatment for retroperitoneal sarcomas (RPS). The role of neoadjuvant chemotherapy (NACT) in improving oncologic outcomes is currently under investigation in the STRASS 2 trial. This study assessed the association between change in tumor size or pathologic response and oncologic outcomes.
Data were retrieved from the international Retroperitoneal Sarcoma Registry and included patients who had RPS treated with NACT between January 2017 and October 2020. The correlation between radiologic response (RECIST1.1), change in tumor size, pathologic response, and oncologic outcomes was evaluated. Binary logistic, Cox, and polynomial spline regression and log-rank tests were performed as statistical analyses.
The study enrolled 141 patients from 14 medical centers. The most common histologies were dedifferentiated liposarcoma (36.9 %) and leiomyosarcoma (34 %). At completion of NACT, 14.5 % of the patients, had a partial response (PR), 63.3 % had stable disease (SD), and 22.2 % had progressive disease (PD). The hazard ratio of PD after NACT for overall survival (OS) was 1.9 (95 % confidence interval [CI], 0.9-4.1). A linear trend was observed between tumor growth and death rate. At early radiologic evaluation during NACT, PD was significantly associated, with worse OS (HR, 5.4; 95 % CI, 1.1-25.3). Partial response was significantly correlated with ≥20 % fibrosis/hyalinization (odds ratio [OR], 5.6; 95 % CI, 1.1-29.0).
Progression in RPS on an early evaluation scan is associated with worse OS, and radiologic response is correlated with pathologic response based on fibrosis/hyalinization. A larger cohort is necessary for more significant associations between radiologic or pathologic response and oncologic outcomes.
完整切除是腹膜后肉瘤（RPS）的主要治疗方法。新辅助化疗（NACT）在改善肿瘤学结局方面的作用目前正在STRASS 2试验中进行研究。本研究评估了肿瘤大小变化或病理反应与肿瘤学结局之间的关联。
从国际腹膜后肉瘤登记处检索数据，纳入2017年1月至2020年10月期间接受NACT治疗的RPS患者。评估了放射学反应（RECIST1.1）、肿瘤大小变化、病理反应与肿瘤学结局之间的相关性。进行二元逻辑回归、Cox回归、多项式样条回归和对数秩检验作为统计分析。
该研究纳入了来自14个医疗中心的141例患者。最常见的组织学类型是去分化脂肪肉瘤（36.9%）和平滑肌肉瘤（34%）。NACT结束时，14.5%的患者有部分缓解（PR），63.3%的患者疾病稳定（SD），22.2%的患者疾病进展（PD）。NACT后PD对总生存期（OS）的风险比为1.9（95%置信区间[CI]，0.9 - 4.1）。观察到肿瘤生长与死亡率之间存在线性趋势。在NACT期间的早期放射学评估中，PD与较差的OS显著相关（HR，5.4；95% CI，1.1 - 25.3）。部分缓解与≥20%的纤维化/玻璃样变显著相关（优势比[OR]，5.6；95% CI，1.1 - 29.0）。
早期评估扫描时RPS进展与较差的OS相关，放射学反应与基于纤维化/玻璃样变的病理反应相关。需要更大的队列来研究放射学或病理反应与肿瘤学结局之间更显著的关联。
