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Prognostic factors affecting survival in metastatic soft tissue sarcoma: an analysis of 110 patients

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Abstract

Background

Data on treatment outcome and prognostic factors in patients with metastatic soft tissue sarcoma (STS) are limited in the literature.

Methods

A total of 119 patients with metastatic STS treated between June 2003 and December 2012 were analyzed for treatment outcome and prognostic factors.

Results

Median age was 37 years (range 2–72 years) with a male to female ratio of 1.5:1. Most common histologic subtypes were synovial sarcoma (36 %) and leiomyosarcoma (16 %). Median tumor size was 12 cm (range 1.6–30 cm). Twenty-four (20 %) patients were treated with multimodality therapy and 80 % patients received systemic chemotherapy alone. At a median follow-up of 10 months (range 1–66 months), the 2-year EFS and OS were 10 and 19 %, respectively, with a median EFS and OS of 6 and 10 months, respectively. Univariate analysis identified albumin ≤4 g/dl (p = 0.001), histologic subtypes other than synovial sarcoma (p = 0.02), non-extremity tumors (p = 0.03) and single modality treatment (p = 0.03) as factors predicting poor EFS; however, for OS, hemoglobin ≤10 g/dl (p = 0.02), tumor size >10 cm (p = 0.01) and single modality treatment (p = 0.04) were identified as poor prognostic factors. Multivariate analysis identified only serum albumin ≤4 g/dl (p = 0.002, HR 0.47, 95 % CI 0.29–0.75) associated with poor EFS; however, for OS, hemoglobin ≤10 g/dl (p = 0.009, HR 0.49, 95 % CI 0.29–0.83), tumor size >10 cm (p = 0.003, HR 2.11, 95 % CI 1.28–3.47) and single modality treatment (p = 0.01, HR 0.47, 95 % CI 0.25–0.86) emerged as poor prognostic factors.

Conclusions

Serum albumin, tumor size, hemoglobin and treatment modality affect survival in metastatic STS.

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References

  1. Van Glabbeke M, van Oosteroom A, Oosterhuis J, Mouridsen H, Crowther D, Somers R, et al. Prognostic factors for the outcome of chemotherapy in advanced soft tissue sarcoma; an analysis of 2,185 patients treated with anthracycline-containing first-line regimens ñ a European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Study. J Clin Oncol. 1999;17:150–7.

    PubMed  Google Scholar 

  2. Coindre JM, Terrier P, Guillou L, Le Doussal V, Collin F, Ranchere D, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas. Cancer. 2001;91:1914–26.

    Article  CAS  PubMed  Google Scholar 

  3. Bauer HC, Trovik CS, Alvegard TA, Berlin O, Erlanson M, Gustafson M, et al. Monitoring referral and treatment in soft tissue sarcoma: study based on 1851 patients from the Scandinavian Sarcoma Group Register. Acta Orthop Scand. 2001;72:150–9.

    Article  CAS  PubMed  Google Scholar 

  4. Karavasilis V, Seddon BM, Ashley S, Al-Muderis O, Fisher C, Judson I. Significant clinical benefit of first-line palliative chemotherapy in advanced soft-tissue sarcoma: retrospective analysis and identification of prognostic factors in 488 patients. Cancer. 2008;112:1585–91.

    Article  PubMed  Google Scholar 

  5. Santoro A, Tursz T, Mouridsen H, Verweij J, Steward W, Somers R, et al. Doxorubicin versus CYVADIC versus doxorubicin plus ifosfamide in first-line treatment of advanced soft tissue sarcomas: a randomized study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. J Clin Oncol. 1995;13:1537–45.

    CAS  PubMed  Google Scholar 

  6. Billingsley KG, Burt ME, Jara E. Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival. Ann Surg. 1999;229:602–10.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Pastorino U, Buyse M, Frielder G. Long- term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg. 1997;113:31–49.

    Article  Google Scholar 

  8. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  CAS  PubMed  Google Scholar 

  9. Mostert S, Arora RS, Arreola M, Bagai P, Friedrich P, Gupta S, et al. Abandonment of treatment for childhood cancer: position statement of a SIOP PODC Working Group. Lancet Oncol. 2011;12(8):719–20. doi:10.1016/S1470-2045(11)70128-0.

    Article  PubMed  Google Scholar 

  10. Italiano A, Mathoulin-Pelissier S, Cesne AL, Terrier P, Bonvalot S, Collin F, et al. Trends in survival for patients with metastatic soft-tissue sarcoma. Cancer. 2011;117:1049–54.

    Article  PubMed  Google Scholar 

  11. Bedi M, King DM, Charlson J, Whitfield R, Hackbarth DA, Zambrano EV, et al. Multimodality management of metastatic patients with soft tissue sarcomas may prolong survival. Am J Clin Oncol. 2014;37:272–7.

    Article  PubMed  Google Scholar 

  12. Sleijfer S, Seynaeve C, Verweij J. Using single-agent therapy in adult patients with advanced soft tissue sarcoma can still be considered standard care. Oncologist. 2005;10:833–41.

    Article  CAS  PubMed  Google Scholar 

  13. Penel N, Bui BN, Bay JO, Cupissol D, Ray-Coquard I, Piperno-Neumann S, et al. Phase II trial of weekly paclitaxel for unresectable angiosarcoma: the ANGIOTAX study. J Clin Oncol. 2008;26:5269–74.

    Article  CAS  PubMed  Google Scholar 

  14. Patel SR, Gandhi V, Jenkins J, Papadopolous N, Burgess MA, Plager C, et al. Phase II clinical investigation of gemcitabine in advanced soft tissue sarcomas and window evaluation of dose rate on gemcitabine triphosphate accumulation. J Clin Oncol. 2001;19:3483–9.

    CAS  PubMed  Google Scholar 

  15. Grosso F, Jones RL, Demetri GD, Judson IR, Blay JY, Le Cesne A, et al. Efficacy of trabectedin (ecteinascidin-743) in advanced pretreated myxoid liposarcomas: a retrospective study. Lancet Oncol. 2007;8:595–602.

    Article  CAS  PubMed  Google Scholar 

  16. Santoro A. Advanced soft tissue sarcoma: how many more trials with anthracyclines and ifosfamide? Ann Oncol. 1999;10:151–4.

    Article  CAS  PubMed  Google Scholar 

  17. Bramwell VH, Anderson D, Charette ML, Sarcoma Disease Site Group. Doxorubicin-based chemotherapy for the palliative treatment of adult patients with locally advanced or metastatic soft tissue sarcoma. Cochrane Database Syst Rev. 2003;(3):CD003293.

  18. Donaldson SS, Meza J, Breneman JC, Crist WM, Laurie F, Qualman SJ, et al. Results from the IRS-IV randomized trial of hyperfractionated radiotherapy in children with rhabdomyosarcoma–a report from the IRSG. Int J Radiat Oncol Biol Phys. 2001;51:718–28.

    Article  CAS  PubMed  Google Scholar 

  19. Ballmer PE, Ochsenbein AF, Schutz-Hofmann S. Transcapillary escape rate of albumin positively correlates with plasma albumin concentration in acute but not in chronic inflammatory disease. Metabolism. 1994;43:697–705.

    Article  CAS  PubMed  Google Scholar 

  20. Maltoni M, Amadori D. Prognosis in advanced cancer. Hematol Oncol Clin North Am. 2002;16:715–29.

    Article  PubMed  Google Scholar 

  21. Onate-Ocana LF, Aiello-Crocifoglio V, Gallardo-Rincon D, Herrera-Goepfert R, Brom-Valladares R, Carrillo JF, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14:381–9.

    Article  PubMed  Google Scholar 

  22. Heys SD, Walker LG, Deehan DJ, Eremin OE. Serum albumin: a prognostic indicator in patients with colorectal cancer. J R Coll Surg Edinb. 1998;43:163–8.

    CAS  PubMed  Google Scholar 

  23. Seve P, Ray-Coquard I, Trillet-Lenoir V, Sawyer M, Hanson J, Broussolle C, et al. Low serum albumin levels and liver metastasis are powerful prognostic markers for survival in patients with carcinomas of unknown primary site. Cancer. 2006;107:2698–705.

    Article  CAS  PubMed  Google Scholar 

  24. Barreto-Andrade JC, Medina-Franco H. Serum albumin is an independent prognostic factor for survival in soft tissue sarcomas. Rev Invest Clin. 2009;61:198–204.

    CAS  PubMed  Google Scholar 

  25. Biswas B, Agarwala S, Rastogi S, Khan SA, Mohanti BK, Sharma DN, et al. High burden of metastases and poor outcome in pelvic PNET. Pediatr Blood Cancer. 2013;60(9):E97–9. doi:10.1002/pbc.24552.

    Article  PubMed  Google Scholar 

  26. 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;14:869–77.

    CAS  PubMed  Google Scholar 

  27. 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;14:1679–89.

    CAS  PubMed  Google Scholar 

  28. Szkandera J, Gerger A, Liegl-Atzwanger B, Stotz M, Samonigg H, Ploner F, et al. Pre-treatment anemia is a poor prognostic factor in soft tissue sarcoma patients. PLoS One. 2014;9(9):e107297. doi:10.1371/journal.pone.0107297.

    Google Scholar 

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Correspondence to S. Bakhshi.

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Iqbal, N., Shukla, N.K., Deo, S.V.S. et al. Prognostic factors affecting survival in metastatic soft tissue sarcoma: an analysis of 110 patients. Clin Transl Oncol 18, 310–316 (2016). https://doi.org/10.1007/s12094-015-1369-9

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