Prognostic stratification using the nomogram sarculator and its impact on study results in a randomized controlled trial (RCT) for localized soft tissue sarcomas (STS): A secondary analysis of the EORTC-STBSG 62931.

Authors

null

Sandro Pasquali

Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

Sandro Pasquali , Sara Pizzamiglio , Nathan Touati , Saskia Litiere , Sandrine Marreaud , Bernd Kasper , Hans Gelderblom , Silvia Stacchiotti , Paolo Verderio , Paolo Giovanni Casali , Penella Woll , Alessandro Gronchi

Organizations

Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium, Universitaersmedizin Mannheim ITZ, Heidelberg, Germany, Leiden University Medical Center, Leiden, Netherlands, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, University of Milan, Milan, Italy, Sheffield ECMC, Sheffield, United Kingdom, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

Research Funding

Other

Background: To determine whether high-risk STS patients identified using individual patient data and the nomogram Sarculator, benefitted from adjuvant chemotherapy in a RCT which failed to detect any overall survival (OS) differences between chemotherapy and observation. Methods: Data from the EORTC 62931 RCT comparing adjuvant doxorubicin plus ifosfamide (Adj) and observation (Obs) for STS (Lancet Oncol 2012;13:1045-1054) were analysed. 10-yr predicted probability of OS (P-OS) was computed using a validated nomogram (Lancet Oncol 2016;17:671-80) for each participant with extremity and trunk wall STS (N = 290/351). Patients were divided in 3 categories of P-OS. OS and disease-free survival (DFS) were calculated at the study median follow-up (8-yr). Results: Nomogram P-OS were dispersed (median 72%, IQR 57-83%) and had prognostic value for OS and DFS (Log-Rank test: P < 0.001). Patients were grouped in 3 arbitrary P-OS categories: > 66% (high P-OS), > 51≤ 66 (intermediate P-OS), ≤ 51% (low P-OS). Most patients were in the high P-OS category (N = 170 [58.6%], 90 Obs/80 Adj), while 68 (23.5%, 34 Obs/34 Adj) and 52 (17.9%, 24 Obs/28 Adj) fell in the intermediate and low P-OS category, respectively. Adjuvant chemotherapy halved the risk of death in patients with low P-OS (HR = 0.46, 95%CI 0.23-0.94) with a 21.2% 8-yr absolute risk reduction (ARR) of death (8-yr OS: 42% and 21% for Adj and Obs, respectively). This effect was not detected in the intermediate (HR = 1.00, 95%CI 0.53-1.88) and high P-OS categories (HR = 1.08, 95%CI 0.61-1.90). There was a DFS benefit for chemotherapy in low P-OS (HR = 0.46, 95%CI 0.24-0.89) but not in the intermediate (HR = 0.74, 95%CI 0.41-1.34) and high P-OS (HR = 0.90, 95%CI 0.54-1.50) categories, leading to a 21% 8-yr ARR for adjuvant chemotherapy (8-yr DFS: 34% and 13% for Adj and Obs, respectively). Conclusions: In this RCT patients with a low predicted P-OS (i.e., high-risk patients) have a statistically significant higher OS and DFS when treated with the study doxorubicin-ifosfamide chemotherapy, although the analysis on all study patients was negative. Clinical trial information: NCT00002641

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Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Sarcoma

Track

Sarcoma

Sub Track

Soft Tissue Tumors

Clinical Trial Registration Number

NCT00002641

Citation

J Clin Oncol 36, 2018 (suppl; abstr 11518)

DOI

10.1200/JCO.2018.36.15_suppl.11518

Abstract #

11518

Poster Bd #

263

Abstract Disclosures