Risk stratification tools to help decide on adjuvant chemotherapy usage in resected soft tissue sarcomas: A 10 year review of an Irish sarcoma centre experience.

Authors

null

Catherine Weadick

Department of Medical Oncology, Cork University Hospital, Cork, Ireland

Catherine Weadick , Rachel J Keogh , Caitriona Goggin , Jake Murphy , Linda Feeley , Michael William Bennett , Seamus O'Reilly , Henry Paul Redmond , Jason Kelly , Deirdre O'Mahony , Sinead Noonan , Jim Clover , Richard Martin Bambury

Organizations

Department of Medical Oncology, Cork University Hospital, Cork, Ireland, Department of Radiation Oncology, Cork University Hospital, Cork, Ireland, Pathology Department, Cork University Hospital, Cork, Ireland, Cancer Research@UCC, University College Cork, Cork, Ireland, Department of Surgery, Cork University Hospital, Cork, Ireland

Research Funding

No funding received
None.

Background: Soft tissue sarcoma (STS) is comprised of 80 pathologic subtypes based on a combination of distinctive morphological, immunohistochemical and molecular features. Adult-type soft tissue and visceral sarcomas are rare, with an estimated incidence of 4-5/100,000/year in Europe. The National Comprehensive Cancer Network (NCCN) guidelines recommend consideration of neo-adjuvant or adjuvant systemic treatment in resectable stage III (high grade tumours which are >5cm) and also in those who need to undergo an amputation or radical resection with adverse functional outcomes. The Sarculator risk prediction tool has identified a threshold of risk above which the administration of chemotherapy may provide an overall survival benefit. This can be applied to the most common histologic subtypes. Patients affected by these subtypes and with a 10-year predicted OS likelihood <60% are considered as high risk and therefore, should be considered for adjuvant chemotherapy. Alternatively, tumours considered at high risk of recurrence based on size >5cm and high grade histology, may benefit from adjuvant chemotherapy. Therefore, the aim of this project is to review the outcomes of resected extremity/trunk soft tissue sarcoma and assess the prognostic accuracy of these risk prediction methods. Methods: All new patients with resected STS discussed in the STS MDT in Cork University Hospital between Jan 2012 – Dec 2021 were identified. The histology and imaging of the identified patients were reviewed. Data regarding demographics, histology, treatment and outcomes was collected. Risk assessment using AJCC and Sarculator score was done on all patients with an extremity or trunk sarcoma. Overall survival was recorded and assessed including Kaplan Meier method for time to event analysis. Results: 200 patients were identified as having an STS resected - 134 of these were located on the trunk or extremities representing 24 different histological subtypes. Sarculator score was calculated for 60 of these (well differentiated liposarcomas, desmoid tumours, and dermatofibrosarcoma protuberans were excluded). 3 patients received adjuvant chemotherapy and 4 patient neoadjuvant chemotherapy. Overall survival data is presented below. Conclusions: Our cohort is representative of the broad histological subtypes expected in sarcoma. Sarculator score results correlate with international outcomes, with higher scores associated with increased mortality. In our cohort, sarculator score was more predictive of outcome than tumour grade/size alone.

Sarculator score – risk assessmentNo. patients No. of deaths5 yr OS rate (n = 30)
High risk198 (42.1%)60.2%p-value = 0.009
Low risk416 (14.6%)87.1%
AJCC staging - risk assessmentNo. patients No. of deaths5 yr OS rate (n = 30)
High risk258 (32%)67.6%p-value = 0.083
Low risk356 (17%)86.3%

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Sarcoma

Track

Sarcoma

Sub Track

Soft Tissue Tumors

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 11575)

DOI

10.1200/JCO.2023.41.16_suppl.11575

Abstract #

11575

Poster Bd #

509

Abstract Disclosures