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Effect of Preoperative Treatment on the Performance of Predictive Nomograms in Primary Retroperitoneal Sarcoma

  • Sarcoma
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A Correction to this article was published on 24 January 2022

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Abstract

Background

Retroperitoneal sarcoma (RPS)-specific nomograms provide estimates of survival and recurrence risk following resection in the individual patient. The effect of preoperative treatment on nomogram performance has not been previously examined. Our aim was to evaluate the predictive accuracy of existing RPS-specific nomograms in patients managed at our center, where the majority of patients received preoperative radiation.

Patients and Methods

All patients who underwent curative treatment for primary RPS at Mount Sinai Hospital/Princess Margaret Hospital between 1996 and 2016 were identified. The performance of four previously published nomograms was assessed by measuring the agreement between nomogram-predicted and observed outcomes using Harrell’s C-Index and level of calibration. Outcomes included in each of the nomograms [overall survival (OS), disease-free survival (DFS), disease-specific death (DSD), local recurrence (LR), distant recurrence (DR)] at each of the specified post-resection timepoints were examined.

Results

In total, 253 patients were included. When observed outcomes were compared with those predicted by each of the four nomograms, the C-Index ranged from 0.60 to 0.81, representing a wide range of predictive accuracy. The lowest C-Index was for prediction of LR. Calibration plots revealed that the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram predicted a 5-year LR of 45%, whereas the observed LR was 24%. Overprediction of LR was detected in patients who had undergone preoperative radiotherapy, but not in patients treated with surgery alone.

Conclusions

Preoperative radiotherapy appeared to preclude the use of the LR component of existing nomograms for primary RPS. Updated nomograms should be created to reflect this variable, particularly in light of the recently published STRASS trial results.

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References

  1. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228(3):355–65.

    Article  CAS  Google Scholar 

  2. Tan MCB, Brennan MF, Kuk D, Agaram NP, Antonescu CR, Qin L-X, 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 

  3. Callegaro D, Raut RC, Ng D, Strauss D, Honoré C, Stoeckle E, Bonvalot S, Haas R, Vassos N, Conti L, Gladdy R, Fairweather M, van Houdt W, Schrage Y, Coevorden F, Rutkowski P, Miceli R, Gronchi A, Swallow C. Has the outcome of patients who undergo resection of primary retroperitoneal sarcoma changed over time? A time-trends study over the past 15 years. Ann Surg Oncol. 2020;28(3):1700–9.

    Article  Google Scholar 

  4. Singer S, Corson JM, Demetri GD, Healey EA, Marcus K, Eberlein TJ. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg. 1995;221(2):185–95.

    Article  CAS  Google Scholar 

  5. Strauss DC, Hayes AJ, Thway K, Moskovic EC, Fisher C, Thomas JM. Surgical management of primary retroperitoneal sarcoma. Br J Surg. 2010;97(5):698–706.

    Article  CAS  Google Scholar 

  6. Catton CN, O’Sullivan B, Kotwall C, Cummings B, Hao Y, Fornasier V. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1994;29(5):1005–10.

    Article  CAS  Google Scholar 

  7. Glencross J, Balasubramanian SP, Bacon J, Robinson MH, Reed MW. An audit of the management of soft tissue sarcoma within a health region in the UK. Eur J Surg Oncol. 2003;29(8):670–5.

    Article  CAS  Google Scholar 

  8. Brennan MF. Staging of soft tissue sarcoma: what is new? Ann Surg Oncol. 2008;15(10):2643. https://doi.org/10.1245/s10434-008-0093-x.

    Article  PubMed  Google Scholar 

  9. Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14(5):1679–89.

    Article  CAS  Google Scholar 

  10. Giuliano K, Nagarajan N, Canner JK, Wolfgang CL, Bivalacqua T, Terezakis S, et al. Predictors of improved survival for patients with retroperitoneal sarcoma. Surgery. 2016;160(6):1628–35.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Fisher SB, Chiang YJ, Feig BW, Cormier JN, Hunt KK, Torres KE, et al. An evaluation of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system for retroperitoneal sarcomas using the National Cancer Data Base (NCDB): does size matter? Am J Clin Oncol. 2019;42(2):160–5.

    Article  Google Scholar 

  13. van Dalen T, Hennipman A, van Coevorden F, Hoekstra HJ, van Geel BN, Slootweg P, et al. Evaluation of a clinically applicable post-surgical classification system for primary retroperitoneal soft-tissue sarcoma. Ann Surg Oncol. 2004;11(5):483–90.

    Article  Google Scholar 

  14. Nathan H, Raut CP, Thornton K, Herman JM, Ahuja N, Schulick RD, et al. Predictors of survival after resection of retroperitoneal sarcoma: a population-based analysis and critical appraisal of the AJCC staging system. Ann Surg. 2009;250(6):970–6.

    Article  Google Scholar 

  15. Singer S, Antonescu CR, Riedel E, Brennan MF. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg. 2003;238(3):358–70.

    Article  Google Scholar 

  16. Gronchi A, Vullo SL, Fiore M, Mussi C, Stacchiotti S, Collini P, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol. 2009;27(1):24–30.

    Article  Google Scholar 

  17. Toulmonde M, Bonvalot S, Méeus P, Stoeckle E, Riou O, Isambert N, et al. Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol. 2014;25(3):735–42.

    Article  CAS  Google Scholar 

  18. Stoeckle E, Coindre J-M, Bonvalot S, Kantor G, Terrier P, Bonichon F, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer. 2001;92(2):359–68.

    Article  CAS  Google Scholar 

  19. 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 

  20. 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 

  21. 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 

  22. Raut CP, Miceli R, Strauss DC, Swallow CJ, Hohenberger P, van Coevorden F, et al. External validation of a multi-institutional retroperitoneal sarcoma nomogram. Cancer. 2016;122(9):1417–24.

    Article  Google Scholar 

  23. Miah AB, Hannay J, Benson C, Thway K, Messiou C, Hayes AJ, et al. Optimal management of primary retroperitoneal sarcoma: an update. Expert Rev Anticancer Ther. 2014;14(5):565–79.

    Article  CAS  Google Scholar 

  24. Raut C, Strauss D, Hass R, Gelderblom H, Bonvalot S, Honoré C, et al. Why primary retroperitoneal sarcoma (PRPS) patients undergoing treatment at STRASS Institutions did not enroll in STRASS: the STREXIT study from EORTC STBSG And TARPSWG. Connective Tissue Oncology Society Meeting Final Program 2018. Abstract ID: 3042602.

  25. Bonvalot S, Gronchi A, Le Péchoux C, Swallow CJ, Strauss D, Meeus P, et al. STRASS (EORTC 62092): A phase III randomized study of preoperative radiotherapy plus surgery versus surgery alone for patients with retroperitoneal sarcoma. Lancet Oncol 2020;21(10):1366–77. https://doi.org/10.1016/S1470-2045(20)30446-0.

    Article  Google Scholar 

  26. Callegaro D, R.C., Ajayi T, Strauss D, Bonvalot S, Ng D, Stoeckle E, Fairweather M, Rutkowski P, van Houdt W, Gelderblom H, Honoré C, Gladdy R, Fau M, Haas R, Marreaud S, Litiere S, Swallow CJ, Gronchi A, Preoperative radiotherapy in patients with primary retroperitoneal sarcoma:trial (STRASS) vs off-trial (STREXIT) results. CTOS Annual Meeting, 2020.

  27. Bonvalot S, Gronchi A, Le Péchoux C, Swallow CJ, Strauss D, Meeus P, et al. Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2020;21(10):1366–77.

    Article  Google Scholar 

  28. Ng D, Burtenshaw S, Olteanu A, Gladdy R, Brar S, Chung P, et al. Why were non-metastatic primary retroperitoneal sarcomas not resected? Connective Tissue Oncology Society Meeting Final Program 2018. Abstract ID: 3042575.

  29. Ma SJ, Oladeru OT, Farrugia MK, Shekher R, Iovoli AJ, Singh AK. Evaluation of preoperative chemotherapy or radiation and overall survival in patients with nonmetastatic, resectable retroperitoneal sarcoma. JAMA Netw Open. 2020;3(11):25529.

    Article  Google Scholar 

  30. Bonvalot S, Miceli R, Berselli M, Causeret S, Colombo C, Mariani L, et al. Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control. Ann Surg Oncol. 2010;17(6):1507–14.

    Article  Google Scholar 

  31. Villano AM, Zeymo A, Chan KS, Shara N, Al-Refaie WB. Identifying the minimum volume threshold for retroperitoneal soft tissue sarcoma resection: merging national data with consensus expert opinion. J Am Coll Surg. 2020;230(1):151–1602.

    Article  Google Scholar 

  32. Sandrucci S, Ponzetti A, Gianotti C, Mussa B, Lista P, Grignani G, et al. Different quality of treatment in retroperitoneal sarcomas (RPS) according to hospital-case volume and surgeon-case volume: a retrospective regional analysis in Italy. Clin Sarcoma Res. 2018;8(3):018–0091.

    Google Scholar 

  33. Callegaro D, Raut CP, Ng D, Strauss DC, Honoré C, Stoeckle E, et al. Has the Outcome for patients who undergo resection of primary retroperitoneal sarcoma changed over time? A study of time trends during the past 15 years. Ann Surg Oncol. 2021;28(3):1700–9.

    Article  Google Scholar 

  34. Trans-Atlantic RPS Working Group. Management of recurrent retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol. 2016;23(11):3531–40. https://doi.org/10.1245/s10434-016-5336-7.

    Article  Google Scholar 

  35. Swallow CJ, Strauss DC, Bonvalot S, Rutkowski P, Desai A, Gladdy RA, et al. Management of primary retroperitoneal sarcoma (RPS) in the adult: an updated consensus approach from the Transatlantic Australasian RPS Working Group. Ann Surg Oncol. 2021;14(10):021–09654.

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada

    Deanna Ng MBBS, David P. Cyr MD, MSc, Sally M. Burtenshaw MSc, Savtaj Brar MD, MSc, Rebecca A. Gladdy MD, PhD & Carol J. Swallow MD, PhD

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Deanna Ng MBBS, David P. Cyr MD, MSc, Sally M. Burtenshaw MSc, Savtaj Brar MD, MSc, Rebecca A. Gladdy MD, PhD & Carol J. Swallow MD, PhD

  3. Institute of Medical Science, University of Toronto, Toronto, Canada

    Deanna Ng MBBS, David P. Cyr MD, MSc & Carol J. Swallow MD, PhD

  4. Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada

    Deanna Ng MBBS, David P. Cyr MD, MSc, Rebecca A. Gladdy MD, PhD & Carol J. Swallow MD, PhD

  5. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Dario Callegaro MD & Alessandro Gronchi MD

  6. Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, 610 University Ave, Toronto, ON, M5G2M9, Canada

    David Shultz MD, Peter Chung MD & Charles Catton MD

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  1. Deanna Ng MBBS
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The original online version of this article was revised: Table 2 and Fig. 3 were corrected.

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Ng, D., Cyr, D.P., Burtenshaw, S.M. et al. Effect of Preoperative Treatment on the Performance of Predictive Nomograms in Primary Retroperitoneal Sarcoma. Ann Surg Oncol 29, 2304–2314 (2022). https://doi.org/10.1245/s10434-021-11156-x

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