Skip to main content
Log in

Defining Which Patients Are at High Risk for Recurrence of Soft Tissue Sarcoma

  • Sarcoma (SH Okuno, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Several studies have investigated the prognosis of soft tissue sarcomas and the influence of a variety of factors, such as size, histology subtype, malignancy grade, site, margins, on overall survival, recurrence-free survival, incidence of local and distant spreading. The impact of genomic and expression profiling on long-term outcomes of patients with sarcomas has been also evaluated in order to fill the knowledge gap of this heterogeneous disease. Nomograms represent a prognostic tool that extends the standard staging systems on an individualized basis, taking into account tumor- and patient-related factors. They are used to assist the health provider and the patients in the decision-making process, for patient counseling, treatment decision-making, follow-up scheduling, and clinical trial eligibility determination. None of the available nomograms include molecular characterization of sarcomas. In the future, omics signatures might be incorporated into prognostic nomograms possibly improving their performance. In the present review, we focus on the complexity of prognostic and predictive factors for extremity and trunk wall as well as for retroperitoneal soft tissue sarcomas, while exploring the available prognostic models.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gundle KR, Kafchinski L, Gupta S, Griffin AM, Dickson BC, Chung PW, et al. Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. J Clin Oncol. 2018;36(7):704–9.

    Article  Google Scholar 

  2. Palassini E, Ferrari S, Verderio P, de Paoli A, Martin Broto J, Quagliuolo V, et al. Feasibility of preoperative chemotherapy with or without radiation therapy in localized soft tissue sarcomas of limbs and superficial trunk in the Italian sarcoma group/grupo Espanol de investigacion en sarcomas randomized clinical trial: three versus five cycles of full-dose epirubicin plus ifosfamide. J Clin Oncol. 2015;33(31):3628–34.

    Article  CAS  Google Scholar 

  3. Beane JD, Yang JC, White D, Steinberg SM, Rosenberg SA, Rudloff U. Efficacy of adjuvant radiation therapy in the treatment of soft tissue sarcoma of the extremity: 20-year follow-up of a randomized prospective trial. Ann Surg Oncol. 2014;21(8):2484–9.

    Article  Google Scholar 

  4. Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.

    Article  CAS  Google Scholar 

  5. • Gronchi A, Strauss DC, Miceli R, Bonvalot S, Swallow CJ, Hohenberger P, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional collaborative RPS working group. Ann Surg. 2016;263(5):1002–9 This paper is important because it underlines the importance of histologic subtype in predicting patterns of recurrence after resection of primary retroperitoneal sarcoma.

    Article  Google Scholar 

  6. Tan MC, Brennan MF, Kuk D, Agaram NP, Antonescu CR, Qin LX, et al. Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma. Ann Surg. 2016;263(3):593–600.

    Article  Google Scholar 

  7. Gronchi A, Bonvalot S, Le Cesne A, Casali PG. Resection of uninvolved adjacent organs can be part of surgery for retroperitoneal soft tissue sarcoma. J Clin Oncol. 2009;27(12):2106–7 author reply 2107-2108.

  8. Coindre JM, Terrier P, Bui NB, Bonichon F, Collin F, le Doussal V, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol. 1996;14(3):869–77.

    Article  CAS  Google Scholar 

  9. Guillou L, Coindre JM, Bonichon F, Nguyen BB, Terrier P, Collin F, et al. Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol. 1997;15(1):350–62.

    Article  CAS  Google Scholar 

  10. Mariani L, Miceli R, Kattan MW, Brennan MF, Colecchia M, Fiore M, et al. Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer. 2005;103(2):402–8.

    Article  Google Scholar 

  11. Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol. 2002;20(3):791–6.

    Article  Google Scholar 

  12. •• Callegaro D, Miceli R, Bonvalot S, Ferguson P, Strauss DC, Levy A, et al. Development and external validation of two nomograms to predict overall survival and occurrence of distant metastases in adults after surgical resection of localised soft-tissue sarcomas of the extremities: a retrospective analysis. Lancet Oncol. 2016;17(5):671–80 These two nomograms for overall survival and distant-metastasis in patients with sarcomas of the extremity are included in the ‘Sarculator’, a freely online available applications, for sarcomas of the retroperitoneum and of the extremity.

    Article  Google Scholar 

  13. •• Callegaro D, Miceli R, Bonvalot S, et al. Development and external validation of a dynamic prognostic nomogram for primary extremity soft tissue sarcoma survivors. EClinicalMedicine. 2019;17:100215 This nomogram allows physician to update the individual survival prediction during follow-up on the basis of baseline variables, time elapsed from surgery and first-event history.

    Article  Google Scholar 

  14. Ferrari S, Ruggieri P, Cefalo G, Tamburini A, Capanna R, Fagioli F, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol. 2012;30(17):2112–8.

    Article  CAS  Google Scholar 

  15. Ferrari S, Smeland S, Mercuri M, Bertoni F, Longhi A, Ruggieri P, et al. Neoadjuvant chemotherapy with high-dose ifosfamide, high-dose methotrexate, cisplatin, and doxorubicin for patients with localized osteosarcoma of the extremity: a joint study by the Italian and Scandinavian Sarcoma Groups. J Clin Oncol. 2005;23(34):8845–52.

    Article  Google Scholar 

  16. Gronchi A, Frustaci S, Mercuri M, Martin J, Lopez-Pousa A, Verderio P, et al. Short, full-dose adjuvant chemotherapy in high-risk adult soft tissue sarcomas: a randomized clinical trial from the Italian Sarcoma Group and the Spanish Sarcoma Group. J Clin Oncol. 2012;30(8):850–6.

    Article  CAS  Google Scholar 

  17. Eilber FC, Brennan MF, Eilber FR, Dry SM, Singer S, Kattan MW. Validation of the postoperative nomogram for 12-year sarcoma-specific mortality. Cancer. 2004;101(10):2270–5.

    Article  Google Scholar 

  18. Bagaria SP, Wagie AE, Gray RJ, et al. Validation of a soft tissue sarcoma nomogram using a national cancer registry. Ann Surg Oncol. 2015;22(Suppl 3):S398–403.

    Article  Google Scholar 

  19. Callegaro D, Fiore M, Gronchi A. Personalizing surgical margins in retroperitoneal sarcomas. Expert Rev Anticancer Ther. 2015;15(5):553–67.

    Article  CAS  Google Scholar 

  20. O'Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235–41.

    Article  Google Scholar 

  21. Callegaro D, Miceli R, Bonvalot S, Ferguson P, Strauss DC, Levy A, et al. Impact of perioperative chemotherapy and radiotherapy in patients with primary extremity soft tissue sarcoma: retrospective analysis across major histological subtypes and major reference centres. Eur J Cancer. 2018;105:19–27.

    Article  Google Scholar 

  22. Woll PJ, Reichardt P, Le Cesne A, et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol. 2012;13(10):1045–54.

    Article  CAS  Google Scholar 

  23. Le Cesne A, Ouali M, Leahy MG, et al. Doxorubicin-based adjuvant chemotherapy in soft tissue sarcoma: pooled analysis of two STBSG-EORTC phase III clinical trials. Ann Oncol. 2014;25(12):2425–32.

    Article  Google Scholar 

  24. •• Pasquali S, Pizzamiglio S, Touati N, Litiere S, Marreaud S, Kasper B, et al. 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. Eur J Cancer. 2019;109:51–60 This paper is very important because stratifying patients with Sarculator was able to define soft tissue sarcoma patients that would benefit of adju- vant/neoadjuvant chemotherapy.

    Article  CAS  Google Scholar 

  25. American Joint Committee on Cancer. AJCC cancer staging manual. 8th ed: Springer Chicago; 2017.

  26. Cahlon O, Brennan MF, Jia X, Qin LX, Singer S, Alektiar KM. A postoperative nomogram for local recurrence risk in extremity soft tissue sarcomas after limb-sparing surgery without adjuvant radiation. Ann Surg. 2012;255(2):343–7.

    Article  Google Scholar 

  27. Ardoino I, Miceli R, Berselli M, Mariani L, Biganzoli E, Fiore M, et al. Histology-specific nomogram for primary retroperitoneal soft tissue sarcoma. Cancer. 2010;116(10):2429–36.

    PubMed  Google Scholar 

  28. Anaya DA, Lahat G, Wang X, Xiao L, Pisters PW, Cormier JN, et al. Postoperative nomogram for survival of patients with retroperitoneal sarcoma treated with curative intent. Ann Oncol. 2010;21(2):397–402.

    Article  CAS  Google Scholar 

  29. • Raut CP, Callegaro D, Miceli R, Barretta F, Rutkowski P, Blay JY, et al. Predicting survival in patients undergoing resection for locally recurrent retroperitoneal sarcoma: a study and novel nomogram from TARPSWG. Clin Cancer Res. 2019;25(8):2664–71 This is the first nomogram predicting disease-free survival and overall survival of patients with local recurrent retroperitoneal sarcoma.

    Article  Google Scholar 

  30. Dalal KM, Kattan MW, Antonescu CR, Brennan MF, Singer S. Subtype specific prognostic nomogram for patients with primary liposarcoma of the retroperitoneum, extremity, or trunk. Ann Surg. 2006;244(3):381–91.

    PubMed  PubMed Central  Google Scholar 

  31. Canter RJ, Qin LX, Maki RG, Brennan MF, Ladanyi M, Singer S. A synovial sarcoma-specific preoperative nomogram supports a survival benefit to ifosfamide-based chemotherapy and improves risk stratification for patients. Clin Cancer Res. 2008;14(24):8191–7.

    Article  CAS  Google Scholar 

  32. Zivanovic O, Jacks LM, Iasonos A, Leitao MM Jr, Soslow RA, Veras E, et al. A nomogram to predict postresection 5-year overall survival for patients with uterine leiomyosarcoma. Cancer. 2012;118(3):660–9.

    Article  Google Scholar 

  33. Gronchi A, Miceli R, Shurell E, Eilber FC, Eilber FR, Anaya DA, et al. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol. 2013;31(13):1649–55.

    Article  Google Scholar 

  34. van Praag VM, Rueten-Budde AJ, Jeys LM, Laitinen MK, Pollock R, Aston W, et al. A prediction model for treatment decisions in high-grade extremity soft-tissue sarcomas: personalised sarcoma care (PERSARC). Eur J Cancer. 2017;83:313–23.

    Article  Google Scholar 

  35. Rueten-Budde AJ, van Praag VM, van de Sande MAJ, Fiocco M, Studygroup P. Dynamic prediction of overall survival for patients with high-grade extremity soft tissue sarcoma. Surg Oncol. 2018;27(4):695–701.

    Article  CAS  Google Scholar 

  36. MacNeill AJ, Miceli R, Strauss DC, Bonvalot S, Hohenberger P, van Coevorden F, et al. Post-relapse outcomes after primary extended resection of retroperitoneal sarcoma: a report from the Trans-Atlantic RPS Working Group. Cancer. 2017;123(11):1971–8.

    Article  CAS  Google Scholar 

  37. Idbaih A, Coindre JM, Derre J, et al. Myxoid malignant fibrous histiocytoma and pleomorphic liposarcoma share very similar genomic imbalances. Lab Investig. 2005;85(2):176–81.

    Article  CAS  Google Scholar 

  38. Chibon F, Mariani O, Mairal A, Derré J, Coindre JM, Terrier P, et al. The use of clustering software for the classification of comparative genomic hybridization data. An analysis of 109 malignant fibrous histiocytomas. Cancer Genet Cytogenet. 2003;141(1):75–8.

    Article  CAS  Google Scholar 

  39. Derre J, Lagace R, Nicolas A, et al. Leiomyosarcomas and most malignant fibrous histiocytomas share very similar comparative genomic hybridization imbalances: an analysis of a series of 27 leiomyosarcomas. Lab Investig. 2001;81(2):211–5.

    Article  CAS  Google Scholar 

  40. Coindre JM, Mariani O, Chibon F, Mairal A, de Saint Aubain Somerhausen N, Favre-Guillevin E, et al. Most malignant fibrous histiocytomas developed in the retroperitoneum are dedifferentiated liposarcomas: a review of 25 cases initially diagnosed as malignant fibrous histiocytoma. Mod Pathol. 2003;16(3):256–62.

    Article  Google Scholar 

  41. Bertucci F, De Nonneville A, Finetti P, et al. The Genomic Grade Index predicts postoperative clinical outcome in patients with soft-tissue sarcoma. Ann Oncol. 2018;29(2):459–65.

    Article  CAS  Google Scholar 

  42. Le Guellec S, Lesluyes T, Sarot E, et al. Validation of the Complexity INdex in SARComas prognostic signature on formalin-fixed, paraffin-embedded, soft-tissue sarcomas. Ann Oncol. 2018;29(8):1828–35.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alessandro Gronchi MD.

Ethics declarations

Conflict of Interest

Gaya Spolverato and Dario Callegaro each declare no potential conflict of interest. Alessandro Gronchi, however, has received research funding from PharmaMar, and has received compensation from Novartis, Pfizer, Bayer, Lilly, PharmaMar, SpringWorks Therapeutics, and Nanobiotix for service as a consultant.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Sarcoma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spolverato, G., Callegaro, D. & Gronchi, A. Defining Which Patients Are at High Risk for Recurrence of Soft Tissue Sarcoma. Curr. Treat. Options in Oncol. 21, 56 (2020). https://doi.org/10.1007/s11864-020-00753-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11864-020-00753-9

Keywords

Navigation