Evaluation of neoadjuvant therapy and histopathologic response in primary, high-grade retroperitoneal sarcomas using the sarcoma nomogram

Authors

  • Timothy R. Donahue MD,

    1. Department of Surgery, Division of Surgical Oncology, University of California at Los Angeles, Los Angeles, California
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  • Michael W. Kattan PhD,

    1. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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  • Scott D. Nelson MD,

    1. Department of Pathology, University of California at Los Angeles, Los Angeles, California
    2. University of California at Los Angeles Sarcoma Program, Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
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  • William D. Tap MD,

    1. University of California at Los Angeles Sarcoma Program, Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
    2. Department of Medicine, Division of Hematology-Oncology, University of California at Los Angeles, Los Angeles, California
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  • Frederick R. Eilber MD,

    1. Department of Surgery, Division of Surgical Oncology, University of California at Los Angeles, Los Angeles, California
    2. University of California at Los Angeles Sarcoma Program, Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
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  • Fritz C. Eilber MD

    Corresponding author
    1. Department of Surgery, Division of Surgical Oncology, University of California at Los Angeles, Los Angeles, California
    2. University of California at Los Angeles Sarcoma Program, Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
    3. Department of Molecular and Medical Pharmacology, University of California at Los Angeles, Los Angeles, California
    • Department of Surgery, Division of Surgical Oncology, University of California at Los Angeles, 10833 LeConte Avenue, Room 54-140 CHS, Los Angeles, CA 90095-1782
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    • Fax: (310) 825-7575


  • Presented in part at the American Society of Clinical Oncology Annual Meeting, Sarcoma Parallel Session, Chicago, Illinois, May 31, 2008.

Abstract

BACKGROUND:

Patients with primary high-grade retroperitoneal soft tissue sarcomas have a 5-year disease-specific survival (DSS) of <40%. The impact of neoadjuvant therapy on histopathologic response and DSS are unknown.

METHODS:

From 1987 to 2007, 55 patients with primary high-grade retroperitoneal sarcoma received neoadjuvant therapy. All patients underwent surgical resection, and response was assessed histopathologically. Patients with ≥95% pathologic necrosis were classified as responders. Clinicopathologic variables were analyzed for association with DSS. Observed DSS was then compared with the Memorial Sloan-Kettering Cancer Center Sarcoma Nomogram predicted DSS.

RESULTS:

The median tumor size was 15 cm, and the median follow-up time for survivors was 68 months. The 5-year DSS for all 55 patients was 47% and did not significantly differ from the 37% predicted by the sarcoma nomogram for such patients (P = .44). Fourteen (25%) of the patients had ≥95% pathologic necrosis and were defined as responders; 41 (75%) were nonresponders. The 5-year DSS for responders was 83%. This was significantly better than the 5-year DSS of 34% for nonresponders (P = .002) and the 39% predicted by the sarcoma nomogram for responders (P = .018). The 34% 5-year DSS for nonresponders did not significantly differ from the 35% predicted by the sarcoma nomogram (P = .51).

CONCLUSIONS:

Neoadjuvant therapy was not associated with an overall improvement in DSS in patients with primary high-grade retroperitoneal sarcoma compared with the sarcoma nomogram prediction. Histopathologic response to neoadjuvant therapy was associated with a significantly improved DSS compared with nonresponders and with the sarcoma nomogram prediction for such patients. Cancer 2010. © 2010 American Cancer Society.

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