Pathologic Response Rates after Neoadjuvant Therapy for Sarcoma: A Single Institution Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Clinical Characteristics
3.2. Treatment and Post-Therapy Response Chracteristics
3.3. Effect of Treatment on pCR
3.4. Predictors of OS and Recurrence
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Category | All | Pathologic Complete Response | ||||
---|---|---|---|---|---|---|
pCR | Non-pCR | |||||
N | % | N | % | N | % | |
All | 79 | 100.0 | 26 | 32.9 | 53 | 67.1 |
Gender | ||||||
Female | 38 | 48.1 | 12 | 31.6 | 26 | 68.4 |
Male | 41 | 51.9 | 14 | 34.1 | 27 | 65.9 |
Age | ||||||
Mean (SD) | 58.4 (14.4) | 59.4 (10.7) | 57.9 (15.9) | |||
Median (Min, Max) | 58.0 (23.0–83.0) | 63.5 (32.0–75.0) | 56.0 (23.0–83.0) | |||
Race/Ethnicity | ||||||
Non-Hispanic White | 39 | 49.4 | 13 | 33.3 | 26 | 66.7 |
Non-Hispanic Black | 10 | 12.7 | 4 | 40.0 | 6 | 60.0 |
Hispanic | 28 | 35.4 | 8 | 28.6 | 20 | 71.4 |
Asian/Unknown | 2 | 2.5 | 1 | 50.0 | 1 | 50.0 |
Location | ||||||
Upper extremity | 13 | 16.5 | 4 | 30.8 | 9 | 69.2 |
Lower extremity | 66 | 83.5 | 22 | 33.3 | 44 | 66.7 |
Histology | ||||||
Fibrosarcoma/Fibroblastic sarcoma | 45 | 57.0 | 16 | 35.6 | 29 | 64.4 |
Leiomyosarcoma | 6 | 7.6 | 1 | 16.7 | 5 | 83.3 |
Myxoid cell/round cell liposarcoma | 5 | 6.3 | 2 | 40.0 | 3 | 60.0 |
Synovial cell sarcoma | 11 | 13.9 | 1 | 9.1 | 10 | 90.9 |
Spindle cell sarcoma | 6 | 7.6 | 4 | 66.7 | 2 | 33.3 |
Dedifferentiated liposarcoma | 6 | 7.6 | 2 | 33.3 | 4 | 66.7 |
Grade | ||||||
2 | 24 | 30.4 | 3 | 12.5 | 21 | 87.5 |
3 | 55 | 69.6 | 23 | 41.8 | 32 | 58.2 |
Clinical T stage | ||||||
1 | 9 | 11.4 | 1 | 11.1 | 8 | 88.9 |
2 | 34 | 43.0 | 11 | 32.4 | 23 | 67.6 |
3 | 19 | 24.1 | 8 | 42.1 | 11 | 57.9 |
4 | 16 | 20.3 | 6 | 37.5 | 10 | 62.5 |
x | 1 | 1.3 | - | - | 1 | 100.0 |
Clinical N stage | ||||||
0 | 76 | 96.2 | 26 | 34.2 | 50 | 65.8 |
1 | 2 | 2.5 | - | - | 2 | 100.0 |
x | 1 | 1.3 | - | - | 1 | 100.0 |
Clinical M stage | ||||||
0 | 74 | 93.7 | 25 | 33.8 | 49 | 66.2 |
1 | 4 | 5.1 | 1 | 25.0 | 3 | 75.0 |
x | 1 | 1.3 | - | - | 1 | 100.0 |
Clinical stage | ||||||
2 | 9 | 11.4 | 1 | 11.1 | 8 | 88.9 |
3 | 63 | 79.7 | 24 | 38.1 | 39 | 61.9 |
4 | 6 | 7.6 | 1 | 16.7 | 5 | 83.3 |
x | 1 | 1.3 | - | - | 1 | 100.0 |
Category | All | Pathologic Complete Response | ||||
---|---|---|---|---|---|---|
pCR | Non-pCR | |||||
N | % | N | % | N | % | |
All | 79 | 100.0 | 26 | 32.9 | 53 | 67.1 |
Neoadjuvant treatment | ||||||
NA-CRT | 40 | 50.6 | 22 | 55.0 | 18 | 45.0 |
NA-CT | 20 | 25.3 | 1 | 5.0 | 19 | 95.0 |
NA-XRT | 19 | 24.1 | 3 | 15.8 | 16 | 84.2 |
Pre-treatment tumor size (cm) | ||||||
<5 | 10 | 12.7 | 1 | 10.0 | 9 | 90.0 |
5–10 | 36 | 45.6 | 12 | 33.3 | 24 | 66.7 |
>10 | 33 | 41.8 | 13 | 39.4 | 20 | 60.6 |
Mean (SD) | 10.4 (5.0) | 11.1 (4.4) | 10.0 (5.4) | |||
Mean (Min, Max) | 9.6 (1.7–29.0) | 10.2 (2.7–20.0) | 8.8 (1.7–29.0) | |||
Post-treatment tumor size (cm) | ||||||
<5 | 14 | 17.7 | 6 | 42.9 | 8 | 57.1 |
5–10 | 32 | 40.5 | 10 | 31.3 | 22 | 68.8 |
>10 | 29 | 36.7 | 9 | 31.0 | 20 | 69.0 |
Unknown | 4 | 5.1 | 1 | 25.0 | 3 | 75.0 |
Mean (SD) | 9.7 (5.7) | 9.3 (5.3) | 10.0 (6.0) | |||
Mean (Min, Max) | 8.0 (0.6–28.0) | 8.1 (2.5–20.0) | 8.0 (0.6–28.0) | |||
Margins | ||||||
Negative | 70 | 88.6 | 26 | 37.1 | 44 | 62.9 |
Positive | 9 | 11.4 | - | - | 9 | 100.0 |
Chemotherapy | ||||||
AI | 27 | 34.2 | 14 | 51.9 | 13 | 48.1 |
MAI | 11 | 13.9 | 4 | 36.4 | 7 | 63.6 |
Adriamycin/Cytoxan | 3 | 3.8 | 1 | 33.3 | 2 | 66.7 |
Adriamycin/Cisplatin | 4 | 5.1 | - | - | 4 | 100.0 |
Other | 15 | 19.0 | 4 | 26.7 | 11 | 73.3 |
Unknown | 19 | 24.1 | 3 | 15.8 | 16 | 84.2 |
Cycles | ||||||
Mean (SD) | 3.7 (1.4) | 33.6 (1.3) | 3.7 (1.4) | |||
Mean (Min, Max) | 4.0 (1.0–7.0) | 4.0 (1.0–6.0) | 4.0 (2.0–7.0) | |||
Vital status | ||||||
Alive | 71 | 89.9 | 26 | 36.6 | 45 | 63.4 |
Dead | 8 | 10.1 | - | - | 8 | 100.0 |
Event of first failure | ||||||
Alive without recurrence | 55 | 69.6 | 22 | 40.0 | 33 | 60.0 |
Local regional/distance recurrence | 23 | 29.1 | 4 | 17.4 | 19 | 82.6 |
Dead without recurrence | 1 | 1.3 | - | - | 1 | 100.0 |
Variable | Category | UVA | MVA | ||
---|---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | ||
Treatment | NA-CRT | Reference | Reference | ||
NA-CT | 15.8 (2.58, 96.9) | 0.003 | 24.7 (2.88,211.2) | 0.003 | |
NA-XRT | 5.73 (1.51, 21.8) | 0.010 | 7.95 (1.87, 33.7) | 0.005 | |
Age in years | One year increased | 0.99 (0.96, 1.03) | 0.678 | ||
Sex | Female | Reference | |||
Male | 0.89 (0.35, 2.28) | 0.816 | |||
Race/ethnicity | Non-Hispanic White | Reference | |||
Non-Hispanic Black | 0.74 (0.18, 3.06) | 0.673 | |||
Hispanic | 1.23 (0.43, 3.51) | 0.701 | |||
Asian/Unknown | 0.51 (0.03, 8.80) | 0.643 | |||
Histology | Leiomyosarcoma | 2.05 (0.27, 15.8) | 0.491 | ||
Myxoid cell/round cell liposarcoma | 0.78 (0.12, 5.13) | 0.799 | |||
Synovial cell sarcoma | 3.92 (0.59, 25.9) | 0.156 | |||
Spindle cell sarcoma | 0.31 (0.05, 1.84) | 0.197 | |||
Dedifferentiated liposarcoma | 1.01 (0.17, 5.96) | 0.994 | |||
Location | Lower extremity | Reference | |||
Upper extremity | 1.07 (0.30, 3.80) | 0.920 | |||
Pre-treatment tumor size in | <5 | Reference | |||
cm | 5–10 | 0.31 (0.04, 2.14) | 0.234 | ||
>10 | 0.24 (0.03, 1.66) | 0.148 | |||
Post-treatment tumor size | <5 | Reference | |||
in cm | 5–10 | 1.64 (0.45, 5.97) | 0.454 | ||
>10 | 1.65 (0.44, 6.15) | 0.455 | |||
Unknown | 1.78 (0.16, 19.37) | 0.635 | |||
Grade | 2 | Reference | Reference | ||
3 | 0.23 (0.06, 0.80) | 0.022 | 0.16 (0.04, 0.7) | 0.015 | |
Clinical T stage | 1 | Reference | |||
2 | 0.36 (0.05, 2.57) | 0.309 | |||
3 | 0.24 (0.03, 1.84) | 0.169 | |||
4 | 0.29 (0.04, 2.30) | 0.239 | |||
x | 0.72 (0.00, 137.1) | 0.901 | |||
Clinical N stage | 0 | Reference | |||
1 | 2.62 (0.06, 111.4) | 0.614 | |||
x | 1.65 (0.02, 164.9) | 0.831 |
Variable | Category | HR (95%CI) | p |
---|---|---|---|
Treatment | NA-CRT | Reference | |
Neoadjuvant treatment | NA-CT | 0.49 (0.07,3.54) | 0.476 |
NA-XRT | 0.59 (0.06,6.36) | 0.667 | |
Age | One year increased | 0.99 (0.93,1.05) | 0.745 |
Sex | Female | Reference | |
Male | 0.12 (0.01,1.03) | 0.054 | |
Race/Ethnicity | Non-Hispanic White | Reference | |
Non-Hispanic Black | 1.32 (0.14,12.2) | 0.807 | |
Hispanic | 0.35 (0.04,3.05) | 0.342 | |
Asian/Unknown | NE | ||
Location | Lower extremity | Reference | |
Upper extremity | 2.34 (0.42,12.9) | 0.330 | |
Pre-treatment tumor (cm) | <5 | Reference | |
5–10 | 0.44 (0.06,3.11) | 0.410 | |
>10 | 0.35 (0.04,2.92) | 0.331 | |
Post treatment tumor (cm) | <5 | NE | |
5–10 | |||
>10 | |||
Unknown | |||
Histology | Fibrosarcoma/Fibroblastic sarcoma | Reference | |
Leiomyosarcoma | NE | ||
Myxoid cell/round cell liposarcoma | NE | ||
Synovial cell sarcoma | 3.96 (0.65,24.3) | 0.137 | |
Spindle cell sarcoma | NE | ||
Grade | 2 | Reference | |
3 | 0.56 (0.11,2.79) | 0.476 | |
Clinical T stage | 1 | Reference | |
2 | 0.37 (0.03,4.65) | 0.440 | |
3 | 1.04 (0.09,12.7) | 0.977 | |
4 | 0.32 (0.02,6.60) | 0.462 | |
x | 1.91 (0.11,33.0) | 0.656 | |
Clinical N stage | 0 | Reference | |
1 | NE | ||
x | 3.63 (0.32,41.5) | 0.299 | |
Clinical M stage | 0 | Reference | |
1 | NE | ||
x | 3.23 (0.30,34.7) | 0.332 | |
Clinical stage | 2 | Reference | |
3 | 0.41 (0.04,4.16) | 0.452 | |
4 | 2.81 (0.16,50.3) | 0.483 | |
x | 1.92 (0.11,33.0) | 0.652 | |
Pathology complete response | pCR | NE | |
(pCR) | Non-pCR |
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Seldon, C.; Shrivastava, G.; Fernandez, M.; Jarboe, J.; Conway, S.; Pretell, J.; Freedman, L.; Wolfson, A.; Zhao, W.; Kwon, D.; et al. Pathologic Response Rates after Neoadjuvant Therapy for Sarcoma: A Single Institution Study. Cancers 2021, 13, 1074. https://doi.org/10.3390/cancers13051074
Seldon C, Shrivastava G, Fernandez M, Jarboe J, Conway S, Pretell J, Freedman L, Wolfson A, Zhao W, Kwon D, et al. Pathologic Response Rates after Neoadjuvant Therapy for Sarcoma: A Single Institution Study. Cancers. 2021; 13(5):1074. https://doi.org/10.3390/cancers13051074
Chicago/Turabian StyleSeldon, Crystal, Gautam Shrivastava, Melanie Fernandez, John Jarboe, Sheila Conway, Juan Pretell, Laura Freedman, Aaron Wolfson, Wei Zhao, Deukwoo Kwon, and et al. 2021. "Pathologic Response Rates after Neoadjuvant Therapy for Sarcoma: A Single Institution Study" Cancers 13, no. 5: 1074. https://doi.org/10.3390/cancers13051074