P. Y. Yu1, E. W. Beal1, L. Suarez-Kelly1, R. Shelby1, T. M. Hughes1, C. G. Ethun2, T. B. Tran3, G. Poultsides3, J. Charlson4, T. C. Gamblin4, J. Tseng5, K. K. Roggin5, K. Chouliaras6, K. Votanopoulos6, B. A. Krasnick7, R. C. Fields7, R. E. Pollock1, V. Grignol1, K. Cardona2, J. H. Howard1 1Ohio State University,Columbus, OH, USA 2Emory University School Of Medicine,Atlanta, GA, USA 3Stanford University,Palo Alto, CA, USA 4Medical College Of Wisconsin,Milwaukee, WI, USA 5University Of Chicago,Chicago, IL, USA 6Wake Forest University School Of Medicine,Winston-Salem, NC, USA 7Washington University,St. Louis, MO, USA
Introduction: The benefit of perioperative chemotherapy (CTX) for treatment of truncal soft-tissue sarcoma (STS) is not well established. Our aim was to determine the effect of CTX on the outcomes of patients with surgically resected primary truncal STS.
Methods: Adult patients with high grade truncal STS who had primary resection for curative intent from 2000-2016 at 7 U.S. institutions were evaluated retrospectively. Patients with well-differentiated liposarcoma, dermatofibrosarcoma protuberans, desmoid tumors, low-grade sarcomas or palliative resections were excluded. Patients were stratified by receipt of CTX. Categorical variables were compared using chi-square or Fisher exact test. Continuous variables were compared using two-sample t-tests or Mann-Whitney U test. Kaplan-Meier curves with log-rank tests were used to compare overall survival (OS) and recurrence-free survival (RFS). Logistic regression models were used to evaluate characteristics associated with OS.
Results: Of patients with high grade truncal STS, 235 received curative intent resections. The most common histology was undifferentiated pleomorphic sarcoma and mean tumor size was 7.8 cm. Thirty percent of the patients received CTX (n=70): 10% (n=24) neoadjuvant CTX, 13% (n=31) adjuvant CTX and 6% (n=15) neoadjuvant and adjuvant CTX. Patients who received CTX were younger (48 vs 59 yrs, p<0.001), less likely to have hypertension (30% vs 50%, p<0.01), more likely to have deep tumors (86 vs 73%, p<0.05), radical resections (87 vs 72%, p<0.05), chest wall/rib resections (43 vs 24%, p<0.01), solid organ invasion (14 vs 3%, p<0.01), longer operative time (228 vs 142 min, p<0.01) and radiation (51 vs 34%, p<0.05). On univariate analysis patients who received CTX had significantly worse OS (p<0.01) and a trend towards worse RFS (p=0.08) (Fig 1). Margin status was the only variable associated with OS on multivariate analysis (OR 4.36, 95% CI 1.56, 12.13, p<0.01).
Conclusion: In this multi-institutional retrospective analysis of high grade truncal STS undergoing curative resection, microscopically-negative margin status was the only independent factor associated with better survival. The receipt of perioperative CTX was not associated with improved OS which may be explained by selection bias. Treating physicians at high-volume sarcoma centers can predict patients likely to have poor outcomes based on clinical and surgical findings. This results in a higher likelihood to administer CTX to patients with worse tumor biology. Our findings emphasize the importance of margin-negative resection as the foundation of optimal sarcoma treatment as well as the need for a better biologic understanding of truncal STS to help guide clinical decision making.
