The impact of chemotherapy on survival of patients with extremity and trunk wall soft tissue sarcoma: revisiting the results of the EORTC-STBSG 62931 randomised trial
Background - This study was aimed at determining whether patients with high-risk soft tissue sarcoma (STS), as identified using the nomogram Sarculator, benefitted from adjuvant chemotherapy in the EORTC-STBSG 62931 randomised controlled trial (RCT), which failed to detect an impact for adjuvant dox...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
25 January 2019
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| In: |
European journal of cancer
Year: 2019, Volume: 109, Pages: 51-60 |
| ISSN: | 1879-0852 |
| DOI: | 10.1016/j.ejca.2018.12.009 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1016/j.ejca.2018.12.009 Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S0959804918315557 
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| Author Notes: | Sandro Pasquali, Sara Pizzamiglio, Nathan Touati, Saskia Litiere, Sandrine Marreaud, Bernd Kasper, Hans Gelderblom, Silvia Stacchiotti, Ian Judson, Angelo P. Dei Tos, Paolo Verderio, Paolo G. Casali, Penella J. Woll, Alessandro Gronchi on behalf of the EORTC-Soft Tissue and Bone Sarcoma Group |
| Summary: | Background - This study was aimed at determining whether patients with high-risk soft tissue sarcoma (STS), as identified using the nomogram Sarculator, benefitted from adjuvant chemotherapy in the EORTC-STBSG 62931 randomised controlled trial (RCT), which failed to detect an impact for adjuvant doxorubicin plus ifosfamide (Adj) over observation (Obs). - Methods - Patients with extremity and trunk wall STS in the EORTC-STBSG 62931 RCT were analysed (N = 290/351). Ten-year predicted probability of overall survival (pr-OS) was calculated using the prognostic nomogram Sarculator. Patients were grouped into three categories of predicted pr-OS: high (pr-OS>66%), intermediate (51<pr-OS≤66) and low (pr-OS≤51%). OS and disease-free survival (DFS) were calculated. - Results - Nomogram pr-OS was dispersed (median 72%, interquartile range 57-83%) and had prognostic value for OS and DFS (log-rank test: P < 0.001). One hundred seventy, 68 and 52 patients had high (58.6%, 90 Obs/80 Adj), intermediate (23.5%, 34 Obs/34 Adj) and low pr-OS (17.9%, 24 Obs/28 Adj), respectively. Adjuvant chemotherapy halved the risk of recurrence (hazard ratio [HR] = 0.46, 95% confidence interval [CI] 0.24-0.89) and death (HR = 0.46, 95% CI 0.23-0.94) in the low pr-OS category, while no effect was detected in intermediate and high pr-OS categories. To strengthen these findings, study participants with pr-OS<60% were combined (N = 80, 27.6%, 39 Obs/41 Adj), and a significant DFS (HR = 0.49, 95% CI 0.28-0.85) and OS (HR = 0.50, 95% CI 0.30-0.90) benefit was detected. - Conclusion - Patients of the EORTC-STBSG 62931 RCT with extremity and trunk wall STS and a low predicted pr-OS (high-risk patients) had better outcomes when treated with adjuvant chemotherapy. This may help reconcile the disparate results of clinical studies on adjuvant/neoadjuvant chemotherapy in STS. |
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| Item Description: | Gesehen am 10.09.2019 |
| Physical Description: | Online Resource |
| ISSN: | 1879-0852 |
| DOI: | 10.1016/j.ejca.2018.12.009 |