Kobbeltvedt M R, Lobmaier I, Spreafico M, Callegaro D, Miceli R, Kizilaslan F, Swanson D, Hompland I, Pasquali S, Fiocco M, van de Sande M A J, Gronchi A, Boye K
Department of Oncology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Pathology, Oslo University Hospital, Oslo, Norway.
ESMO Open. 2025 Jul 24;10(8):105517. doi: 10.1016/j.esmoop.2025.105517.
Different risk classification criteria are used to select patients with localized soft tissue sarcoma of the extremities and trunk wall for neoadjuvant/adjuvant chemotherapy. The two most frequently used risk classification methods are PERSARC and Sarculator prediction models. The main aim was to evaluate and compare these two methods.
The study cohort consisted of 664 patients treated at Oslo University Hospital from 1998 to 2017. Predicted probabilities of distant metastasis (DM) and overall survival (OS) were calculated, and risk classification was carried out according to previously defined thresholds. Hazard ratios were estimated using Cox proportional hazards regression models. Interaction between neoadjuvant/adjuvant chemotherapy and risk groups was included in the models to investigate the effect of chemotherapy according to risk group.
A high degree of correlation was found between PERSARC and Sarculator in predicted 5-year probability of DM and 5-year OS. A total of 215 of 664 (32%) and 221 of 569 (39%) patients were classified as high-risk according to Sarculator and PERSARC, respectively, with agreement found in 511 of 569 patients (90%). Patients classified as high-risk by only one method had similar disease-free survival and OS as patients who were high-risk using both methods. Based on this, patients classified as high-risk by at least one method were grouped as 'combined high-risk' and compared with previously established risk classification criteria. Neoadjuvant/adjuvant chemotherapy was associated with improved OS and disease-free survival in all high-risk groups.
A high degree of agreement between PERSARC and Sarculator predictions was observed. Patients classified as high-risk by only one method had similar outcomes to those who were high-risk using both. Chemotherapy was associated with improved outcome in the PERSARC, Sarculator, and combined high-risk group. Patients classified as high-risk by one of these methods could be considered for neoadjuvant/adjuvant chemotherapy.
不同的风险分类标准用于选择肢体和躯干壁局限性软组织肉瘤患者进行新辅助/辅助化疗。两种最常用的风险分类方法是PERSARC和Sarculator预测模型。主要目的是评估和比较这两种方法。
研究队列包括1998年至2017年在奥斯陆大学医院接受治疗的664例患者。计算远处转移（DM）和总生存期（OS）的预测概率，并根据先前定义的阈值进行风险分类。使用Cox比例风险回归模型估计风险比。模型中纳入新辅助/辅助化疗与风险组之间的相互作用，以研究化疗根据风险组的效果。
在预测的5年DM概率和5年OS方面，PERSARC和Sarculator之间发现高度相关性。664例患者中有215例（32%），569例患者中有221例（39%）分别根据Sarculator和PERSARC被分类为高危，569例患者中有511例（90%）结果一致。仅通过一种方法分类为高危的患者与通过两种方法均为高危的患者具有相似的无病生存期和总生存期。基于此，将至少通过一种方法分类为高危的患者归为“联合高危”组，并与先前确立的风险分类标准进行比较。在所有高危组中，新辅助/辅助化疗与改善的总生存期和无病生存期相关。
观察到PERSARC和Sarculator预测之间高度一致。仅通过一种方法分类为高危的患者与通过两种方法均为高危的患者具有相似的结局。化疗与PERSARC、Sarculator和联合高危组中改善的结局相关。通过这些方法之一分类为高危的患者可考虑进行新辅助/辅助化疗。
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