Incidence and predictive factors of late relapse in patients with soft tissue sarcomas: Implications for prolonged follow-up.

10574 Background: There is no consensus on how to follow soft-tissue sarcoma (STS) patients after their initial management. In particular, the incidence of late relapse which would justify prolonged surveillance is unknown. Methods: Follow-up data were reviewed from 719 patients with localized STS, included in the French Sarcoma Group database from January 1990 to June 2005, and who achieved complete remission maintained for at least five years after their initial management. The outcomes of interest were the cumulative probabilities of late (> 5 years) local and metastatic relapse with death as a competing event. Estimations and 95% confidence intervals (CIs) were computed with the cumulative incidence function. Patients who did not experience the event of interest or death over the course of the study were censored at their last follow-up. Results: 67 (9.3%) and 42 (5.8%) patients had late local and metastatic relapse respectively. On univariate analysis, internal trunk location, liposarcoma histological subtype, tumor size > 10 cm, R1 margins, no adjuvant radiotherapy were significantly associated with increased risk of late local relapse. On multivariate analysis, internal trunk location (HR= 3.9, 95% CI 2.2-6.7, p<0.001) and tumor size > 10 cm (HR= 2.1, 95% CI 1.1-4, p=0.03) were the two factors independently associated with local relapse. On univariate analysis, leiomyosarcoma histological subtype, and grade > 1 were significantly associated with increased risk of late metastatic relapse. On multivariate analysis, grade > 1 (HR= 4.7, 95% CI 1.1-21, p=0.04) was the sole factor independently associated with the risk of late metastatic relapse. Conclusions: Late relapse of STS (> 5 years after initial management) is relatively uncommon. However, its existence and our results emphasize the critical role of long-term follow-up to detect late local recurrence in patients with retroperitoneal or very large STS and late metastatic recurrence in patients with high grade disease.

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Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation

Journal of Neurosurgery Spine ◽

10.3171/2015.10.spine141261 ◽

2016 ◽

Vol 24 (6) ◽

pp. 928-936 ◽

Cited By ~ 50

Author(s):

Maha Saada Jawad ◽

Daniel K. Fahim ◽

Peter C. Gerszten ◽

John C. Flickinger ◽

Arjun Sahgal ◽

...

Keyword(s):

Multivariate Analysis ◽

Vertebral Compression Fracture ◽

Stereotactic Body Radiation Therapy ◽

Univariate Analysis ◽

Compression Fracture ◽

Target Delineation ◽

Solitary Metastasis ◽

Increased Risk ◽

Prescription Dose

OBJECTIVE The purpose of this study was to identify factors contributing to an increased risk for vertebral compression fracture (VCF) following stereotactic body radiation therapy (SBRT) for spinal tumors. METHODS A total of 594 tumors were treated with spinal SBRT as primary treatment or re-irradiation at 8 different institutions as part of a multi-institutional research consortium. Patients underwent LINAC-based, image-guided SBRT to a median dose of 20 Gy (range 8–40 Gy) in a median of 1 fraction (range 1–5 fractions). Median patient age was 62 years. Seventy-one percent of tumors were osteolytic, and a preexisting vertebral compression fracture (VCF) was present in 24% of cases. Toxicity was assessed following treatment. Univariate and multivariate analyses were performed using a logistic regression method to determine parameters predictive for post-SBRT VCF. RESULTS At a median follow-up of 10.1 months (range 0.03–57 months), 80% of patients had local tumor control. At the time of last imaging follow-up, at a median of 8.8 months after SBRT, 3% had a new VCF, and 2.7% had a progressive VCF. For development of any (new or progressive) VCF following SBRT, the following factors were predictive for VCF on univariate analysis: short interval from primary diagnosis to SBRT (less than 36.8 days), solitary metastasis, no additional bone metastases, no prior chemotherapy, preexisting VCF, no MRI used for target delineation, tumor volume of 37.3 cm3 or larger, equivalent 2-Gy-dose (EQD2) tumor of 41.8 Gy or more, and EQD2 spinal cord Dmax of 46.1 Gy or more. Preexisting VCF, solitary metastasis, and prescription dose of 38.4 Gy or more were predictive on multivariate analysis. The following factors were predictive of a new VCF on univariate analysis: solitary metastasis, no additional bone metastases, and no MRI used for target delineation. Presence of a solitary metastasis and lack of MRI for target delineation remained significant on multivariate analysis. CONCLUSIONS A VCF following SBRT is more likely to occur following treatment for a solitary spinal metastasis, reflecting a more aggressive treatment approach in patients with adequately controlled systemic disease. Higher prescription dose and a preexisting VCF also put patients at increased risk for post-SBRT VCF. In these patients, pre-SBRT cement augmentation could be considered to decrease the risk of subsequent VCF.

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The risk of debilitating falls in Manitobans living with prostate cancer (pc).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.244 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 244-244

Author(s):

Joel Roger Gingerich ◽

Pascal Lambert ◽

Malcolm Doupe ◽

Paul Joseph Daeninck ◽

Marshall W. Pitz ◽

...

Keyword(s):

Multivariate Analysis ◽

Cumulative Incidence ◽

Large Population ◽

Univariate Analysis ◽

Population Based ◽

Community Dwelling ◽

Low Grade ◽

Population Based Study ◽

Increased Risk

244 Background: Falls and fall-related injuries are important patient safety problems. Some studies suggest that pc patients have higher fall rates, however the severity of these falls is unknown. We sought to measure if pc patients are at increased risk of a debilitating fall requiring hospitalization. Methods: This is a retrospective population-based study utilizing the Manitoba Cancer Registry and Manitoba Health administrative databases. Our cohort consists of all community-dwelling patients living in Manitoba Canada who were diagnosed with pc between 2004 and 2008. These individuals were matched by age, sex, and time of diagnosis with up to three cancer-free controls. Debilitating falls were defined as falls/fractures requiring hospitalization and were identified using ICD-9 and -10 billing codes. A competing risk model was used to compare debilitating falls between the pc and cancer-free cohorts and expressed as sub-hazard ratios. Follow-up ended December 31, 2009. Results: 2,903 pc patients were identified along with 8,686 matched controls. The mean age was 69.3 and 68.8 respectively. The median follow-up was 3.05 years. Debilitating falls were identified in 109 patients (3.8%) with pc and 345 (4%) matched controls. The cumulative incidence of debilitating falls for those with pc vs cancer-free controls were: 1.08% vs. 1.13% at 1-year and 5.25% vs. 5.96% at five years of follow-up (SHR = 0.95, 95% CI = 0.77 – 1.18, p = 0.65). On univariate analysis, patients with stage IV pc were at higher risk of falls compared to matched controls. This difference was not significant on multivariate analysis though (SHR = 1.19, 95% CI = 0.74 – 1.89, p = 0.48). On multivariate analysis, patients with a Gleason score of ≤6 experienced a reduced risk of debilitating falls compared to matched controls (SHR = 0.44, 95% CI = 0.27 – 0.72, p = 0.001), whereas patients with other Gleason scores did not. The analysis was similar when patients with fractures were excluded. Conclusions: In this large population-based study, the 1- and 5-year cumulative incidence of debilitating falls did not differ significantly for patients with vs without pc. In fact, compared to matched controls, low grade pc patients were less likely to experience a debilitating fall.

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Breast Implant-Associated Anaplastic Large Cell Lymphoma: Treatment Experience In 53 Patients

Blood ◽

10.1182/blood.v122.21.5089.5089 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5089-5089 ◽

Cited By ~ 2

Author(s):

Alexandra Hart ◽

Mary Jo Lechowicz

Keyword(s):

Bone Marrow ◽

Multivariate Analysis ◽

Cell Lymphoma ◽

Breast Implant ◽

Univariate Analysis ◽

Large Cell ◽

Increased Risk ◽

Disease Extension ◽

Large Cell Lymphoma

Purpose Primary breast lymphomas are exceedingly rare; yet, recent reports continue to describe cases of breast implant-associated anaplastic large cell lymphoma (bi-ALCL). Every year over 250,000 women receive breast implants for cosmetic and reconstructive purposes making it necessary to explore the potential consequences of this emerging disease. Although the majority of cases follow an indolent clinical course, there have been several patient (pt) deaths reported, emphasizing the importance of investigation into variables associated with poor clinical outcomes. The purpose of this study is to describe pts diagnosed with bi-ALCL in order to enhance our management and treatment of this disease. Methods A review of the literature using search engines PubMed and MEDLINE were conducted using search terms “Anaplastic” AND “Lymphoma” AND “Breast,” “ALCL” AND “Breast” AND “Implants,” and “Anaplastic” AND “Breast” AND “Implant.” Articles were analyzed for accurate diagnoses excluding any duplicate pts. Two pts at our institution were reviewed using medical records. Univariate analysis determined significant associations (p<0.05). Multivariate analysis was performed when adequate pt data available. Results Sixty-two pts with bi-ALCL were identified from 29 publications, and two additional pts from our clinical practice were included. Eleven pts were excluded secondary to lack of treatment data. Clinical variables are summarized in Table 1. Twelve pts presented with extracapsular disease. Sixteen of 53 (23.1%) pts presented with a mass. Only nine pts (17%) were adequately staged for NHL. Twenty-one pts received a PET scan, and 9 received a bone marrow biopsy. Twenty one pts (39.6%) received surgery alone, 5 pts (9.4%) received surgery and radiation, 10 pts (18.9%) received surgery and chemotherapy, and 16 pts (30.2%) received surgery, chemotherapy, and radiation, and one pt (1.9%) received chemotherapy alone. CHOP (n=23, 43.4%) was the most common chemotherapy regimen. One pt received a bone marrow transplant (BMT) for upfront consolidative therapy. The median follow up is 15 months (3.6-90 months). Fifteen pts (28.3%) had recurrent disease. Eleven of those 15 pts (73.3%) were treated with salvage chemotherapy. Of those six received CHOP, two received ICE salvage, and three had an autologous BMT. Four patients died from their disease. Univariate analysis demonstrated extracapsular disease extension is associated with increased risk for recurrence (p<.0001) and pt death (p=0.0008). B symptoms at presentation were associated with pt death (p=0.012). Pts presenting with a mass were not at increased odds for recurrence (p=0.36) but were at increased odds for death (p=0.043). Multivariate analysis did not show any significant difference in the odds for recurrence among different treatment modalities. Conclusion This represents the largest series of pts with bi-ALCL described to date. Our analysis confirms extracapsular disease extension is associated with increased risk for recurrence and patient death. Established protocols for NHL staging have not been routinely utilized. More detailed follow-up is necessary for prognostic data in this patient population. Future treatment guidelines will require a multi-disciplinary unified approach. Disclosures: No relevant conflicts of interest to declare.

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PROGNOSTIC FACTORS OF RENAL TUMOR RECURRENCE AFTER RADICAL NEPHRECTOMY

British Journal of Surgery ◽

10.1093/bjs/znab160.044 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

G Martínez Izquierdo ◽

A R Arnaiz Pérez ◽

E Escolano Fernández ◽

M Merayo Álvarez ◽

B Carrasco Aguilera ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Radical Nephrectomy ◽

Univariate Analysis ◽

Malignant Neoplasms ◽

Histopathological Analysis ◽

Chi Square ◽

Renal Sinus ◽

Chi Square Test

Abstract INTRODUCTION Renal cell carcinoma (RCC) represents 3% of overall malignant neoplasms in adults. However, its aetiology has not been clearly established. Although surgery represents the cornerstone in treatment, recurrence postoperative rates are around 20-30%, what implies prognostic factors search must be mandatory in order to help to plan de follow-up and the different adjuvant therapy possibilities available in case they were necessary. MATERIAL AND METHODS A retrospective observational study was carried out in 110 patients who underwent radical nephrectomy between 2004 and 2018, with the aim of identifying possible prognostic factors of recurrence of RCC after these surgeries. Preoperative data (epidemiological, comorbidities and laboratory tests), surgical, pathological and variables related to follow-up were taken into account. A univariate and multivariate analysis were performed, using chi-square test and logistic regression, respectively. RESULTS The median follow-up time was 53.5 months (SD = 35.8), time in which 19 patients had a recurrence of RCC after radical nephrectomy (17.2%). Histopathological items such as the surgical piece size, the nodal and microvascular invasion, the renal sinus invasion and the presence of necrosis in the surgical piece were associated with RCC recurrence in the univariate analysis, while only the presence of necrosis in the surgical piece showed a significant result in the multivariate analysis (p = 0.004). CONCLUSIONS Histopathological analysis, highlighting the presence of necrosis in the histological sample, was proved to be the main risk factor of RCC recurrence.

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Eculizumab discontinuation in atypical hemolytic uremic syndrome: TMA recurrence risk and renal outcomes

Clinical Kidney Journal ◽

10.1093/ckj/sfab005 ◽

2021 ◽

Author(s):

Gema Ariceta ◽

Fadi Fakhouri ◽

Lisa Sartz ◽

Benjamin Miller ◽

Vasilis Nikolaou ◽

...

Keyword(s):

Family History ◽

Hemolytic Uremic Syndrome ◽

Univariate Analysis ◽

Atypical Hemolytic Uremic Syndrome ◽

Renal Response ◽

Pathogenic Variants ◽

Increased Risk ◽

History Of ◽

Uremic Syndrome

ABSTRACT Background Eculizumab modifies the course of disease in patients with atypical hemolytic uremic syndrome (aHUS), but data evaluating whether eculizumab discontinuation is safe are limited. Methods Patients enrolled in the Global aHUS Registry who received ≥1 month of eculizumab before discontinuing, demonstrated hematologic or renal response prior to discontinuation and had ≥6 months of follow-up were analyzed. The primary endpoint was the proportion of patients suffering thrombotic microangiopathy (TMA) recurrence after eculizumab discontinuation. Additional endpoints included: eGFR changes following eculizumab discontinuation to last available follow-up; number of TMA recurrences; time to TMA recurrence; proportion of patients restarting eculizumab; and changes in renal function. Results We analyzed 151 patients with clinically diagnosed aHUS who had evidence of hematologic or renal response to eculizumab, before discontinuing. Thirty-three (22%) experienced a TMA recurrence. Univariate analysis revealed that patients with an increased risk of TMA recurrence after discontinuing eculizumab were those with a history of extrarenal manifestations prior to initiating eculizumab, pathogenic variants, or a family history of aHUS. Multivariate analysis showed an increased risk of TMA recurrence in patients with pathogenic variants and a family history of aHUS. Twelve (8%) patients progressed to end-stage renal disease after eculizumab discontinuation; 7 (5%) patients eventually received a kidney transplant. Forty (27%) patients experienced an extrarenal manifestation of aHUS after eculizumab discontinuation. Conclusions Eculizumab discontinuation in patients with aHUS is not without risk, potentially leading to TMA recurrence and renal failure. A thorough assessment of risk factors prior to the decision to discontinue eculizumab is essential.

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Distant metastases after diagnosis: Racial disparities in breast cancer outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1084 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1084-1084

Author(s):

Julia Blanter ◽

Ilana Ramer ◽

Justina Ray ◽

Emily J. Gallagher ◽

Nina A. Bickell ◽

...

Keyword(s):

Breast Cancer ◽

Multivariate Analysis ◽

Black Women ◽

Racial Disparities ◽

Late Stage ◽

White Women ◽

Univariate Analysis ◽

Distant Metastases ◽

Stage At Diagnosis

1084 Background: Black women diagnosed with breast cancer are more likely to have a poor prognosis, regardless of breast cancer subtype. Despite having a lower incidence rate of breast cancer when compared to white women, black women have the highest breast cancer death rate of all racial and ethnic groups, a characteristic often attributed to late stage at diagnosis. Distant metastases are considered the leading cause of death from breast cancer. We performed a follow up study of women with breast cancer in the Mount Sinai Health System (MSHS) to determine differences in distant metastases rates among black versus white women. Methods: Women were initially recruited as part of an NIH funded cross-sectional study from 2013-2020 to examine the link between insulin resistance (IR) and breast cancer prognosis. Women self-identified as black or white race. Data was collected via retrospective analysis of electronic medical records (EMR) between September 2020-January 2021. Distant metastases at diagnosis was defined as evidence of metastases in a secondary organ (not lymph node). Stage at diagnosis was recorded for all patients. Distant metastases after diagnosis was defined as evidence of metastases at any time after initiation of treatment. Univariate analysis was performed using Fisher’s exact test, multivariate analysis was performed by binary logistic regression, and results expressed as odds ratio (OR) and 95% confidence interval (CI). A p value <0.05 was considered statistically significant. Results: We identified 441 women enrolled in the IR study within the MSHS (340 white women, 101 black women). Median follow up time for all women was 2.95 years (median = 3.12 years for white and 2.51 years for black women (p=0.017)). Among these patients, 11 developed distant metastases after diagnosis: 4 (1.2%) white and 7 (6.9%) black (p=0.004). Multivariate analysis adjusting for age, race and stage at diagnosis revealed that black women were more likely to have distant metastasis (OR 5.8, CI 1.3-25.2), as were younger women (OR for age (years) 0.9, CI 0.9-1.0), and those with more advanced stage at diagnosis. Conclusions: Black women demonstrated a far higher percentage of distant metastases after diagnosis even when accounting for age and stage. These findings suggest that racial disparities still exist in the development of distant metastases, independent from a late-stage diagnosis. The source of existing disparities needs to be further understood and may be found in surveillance, treatment differences, or follow up.

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Minor salivary gland biopsy: its importance in rheumatoid arthritis and secondary Sjögren's síndrome

Revista Argentina de Reumatología ◽

10.47196/rar.v30i3.442 ◽

2019 ◽

pp. 15-18

Author(s):

María Florencia Rodriguez ◽

Cristian Troitiño ◽

Felix Enrique Romanini ◽

Anastasia Secco

Keyword(s):

Rheumatoid Arthritis ◽

Multivariate Analysis ◽

Salivary Gland ◽

Interstitial Lung Disease ◽

Univariate Analysis ◽

Minor Salivary Gland ◽

Minor Salivary Gland Biopsy ◽

Extraglandular Manifestations ◽

Salivary Gland Biopsy

Secondary Sjögren’s Syndrome (SSs) is common in patients with Rheumatoid Arthritis (RA). Objectives: to determine if lymphocytic sialoadenifitis (FLS) is associated with clinical and serological differences in a group of patients with RA and SSs. Methods: patients with a diagnosis of RA and SSs were included, which of them presented FLS in the salivary gland biopsy, clinical and serological characteristics were compared. Results: 88 patients were included, 92% women, mean age of 53 years (SD ± 11.3) and 12.5 years of evolution of RA (RIC 6-7). 63.6% had SLF versus 36.4% who did not. In the univariate analysis, a statistically significant association was found between FLS + and the variables: parotidomegaly, interstitial lung disease, hypergammaglobulinemia, hypocomplementemia, rheumatoid factor, positive ANF, and extra-articular and/ or extraglandular manifestations. In the multivariate analysis, the variables independently associated with the presence of FLS were: extra-articular and/or extraglandular manifestations (OR 5.67, 95% CI 1.6-20), positive ANF (OR 11.7, 95% CI 1.6-83) and hypergammaglobulinemia (OR 21, 95% CI 2.46-179). Conclusion: patients with RA and SSs with FLS have a higher frequency of extra-articular and extraglandular manifestations and serological differences, which would imply a different clinical follow-up.

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Impact of superselective intra-arterial and systemic chemoradiotherapy for gingival carcinoma; analysis of treatment outcomes and prognostic factors

10.21203/rs.3.rs-56332/v2 ◽

2020 ◽

Author(s):

Yuki Mukai ◽

Yuichiro Hayashi ◽

Izumi Koike ◽

Toshiyuki Koizumi ◽

Madoka Sugiura ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Clinical Stage ◽

Performance Status ◽

Univariate Analysis ◽

Stage Iv ◽

Progression Free Survival ◽

Late Toxicity ◽

Free Survival

Abstract Background: We compared outcomes and toxicities between concurrent retrograde super-selective intra-arterial chemoradiotherapy (IACRT) and concurrent systemic chemoradiotherapy (SCRT) for gingival carcinoma (GC).　Methods: We included 84 consecutive patients who were treated for non-metastatic GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n=66; SCRT group: n=18).Results: The median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT: 60 Gy; SCRT: 69 Gy). There were significant differences between the two groups in terms of 3-year overall survival (OS; IACRT: 78.8%, 95% confidence interval [CI]: 66.0–87.6; SCRT: 50.4%, 95% CI: 27.6–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.6%, 95% CI: 62.7–85.2; SCRT: 42.0%, 95% CI: 17.7–70.9; P = 0.028) and local control rates (LC; IACRT: 77.2%, 95% CI: 64.2–86.4; SCRT: 42.0%, 95% CI: 17.7–70.9; P = 0.015). In univariate analysis, age ≥ 65 years, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with a poor OS rate (P < 0.05). Patients with poorer PS had a significantly worse PFS rate. Regarding acute toxicity, 22 IACRT patients had grade 4 lymphopenia, and osteoradionecrosis was the most common late toxicity in both groups.Conclusions: This is the first report to compare outcomes from IACRT and SCRT among patients with GC. ALL therapy related toxicities were manageable. IACRT is an effective and safe treatment for GC.

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Risk Factors for Progression in Vestibular Schwannomas After Incomplete Resection: A Single Center Retrospective Study

Frontiers in Neurology ◽

10.3389/fneur.2021.778590 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jiuhong Li ◽

Xueyun Deng ◽

Daibo Ke ◽

Jian Cheng ◽

Si Zhang ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Tumor Size ◽

Tumor Volume ◽

Univariate Analysis ◽

Residual Tumor ◽

Vestibular Schwannomas ◽

Incomplete Resection ◽

Cystic Component

Background and Purpose: The risk factors for progression in vestibular schwannomas (VSs) after incomplete resection (IR) remain to be elucidated. The purpose of this study was to investigate the risk factors for progression in remnant VSs after surgery.Methods: From January 2009 to January 2018, 140 consecutive patients who underwent IR of VSs via suboccipital retrosigmoid approach in our institution were retrospectively analyzed. During follow-up, if progression was detected, the patient was classified into Progressive Group (PG); if the residual tumor was stable or shrank, the patient was classified into Stable Group (SG). Univariate analysis and multivariate analysis were used to evaluate the risk factors for progression after IR of VSs.Results: After a mean follow-up of 80.4 months (range, 24–134 months), 35 (25.0%) patients (PG) had a progression, and no progression was detected in 105 (75.0%) patients (SG). The average tumor size was 36.5 ± 8.9 mm in PG and 31.0 ± 9.8 mm in SG, respectively. The residual tumor volume was 304.6 ± 443.3 mm3 in PG and 75.9 ± 60.0 mm3 in SG, respectively. Univariate analysis showed that preoperative tumor size, residual tumor volume, and irregular internal auditory canal (IAC) expansion were significantly different between the two groups, whereas gender, age, cystic component, or Ki-67 labeling index (LI) did not differ significantly between the two groups. Multivariate analysis showed residual tumor volume was the independent risk factor for progression.Conclusions: VSs that underwent IR with larger preoperative size, greater residual tumor volume, or irregular IAC expansion may have a higher progression rate. Strict follow-up with shorter interval in these patients to detect early progression is necessary.

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Impact of interdisciplinary sarcoma board evaluation on treatment outcome of primary soft-tissue sarcoma patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e23540 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e23540-e23540

Author(s):

Jana Kaethe Striefler ◽

Annika Strönisch ◽

Daniel Rau ◽

David Kaul ◽

Georgios Koulaxouzidis ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Tumor Stage ◽

Quality Parameters ◽

Low Grade ◽

Early Presentation ◽

Risk Of Death ◽

Increased Risk ◽

Interdisciplinary Approaches

e23540 Background: Early presentation of soft-tissue sarcoma (STS) patients to a specialized sarcoma center including discussion in the interdisciplinary sarcoma board (ISB) prior to surgery is essential to the treatment of sarcomas. This approach significantly improves patient survival and guideline coherence. However, there exists only limited information on the adherence to the recommendations of the ISB. Accordingly, we decided to analyze a STS cohort at a large German sarcoma center focusing on outcome parameters and adherence to quality parameters defined by the German Cancer Society (Deutsche Krebsgesellschaft). Methods: In a retrospective data analysis, we identified n = 230 adult patients presented at the ISB of the Charité–Universitätsmedizin Berlin in Germany from January 2015 until December 2019. Inclusion criteria were as follows: newly diagnosed STS, presentation during first-line therapy and recommendation of at least one treatment modality such as surgery, chemotherapy, radiotherapy, regional hyperthermia or follow-up by the ISB. Clinical and follow up data was collected by using the hospital information system and the outpatient network. Results: Our patient cohort included 53% male and 47% female patients with a median age of 58 years (range 19-96). The majority (86%) showed a localized tumor stage, while 14% already had metastases. In 24% of the cases the sarcomas were classified as low-grade, in 76% as high-grade. Surgery was recommended for 66% of the cases, for 80% of them combined with chemotherapy, radiotherapy or hyperthermia. 14% of the patients received a recommendation for all 4 modalities. For 9% of the patients, chemotherapy alone was recommended. Both overall survival and progression-free survival was significantly higher in the group with complete adherence to the recommendations of the ISB (p < 0.001). The worst prognosis was found in patients unable to adhere to the recommendations due to rapid progression or complications of the therapy (HR for death 15.06, 95%CI 7.94-32.22). If one recommended modality was not carried out, there also was a higher risk of death (HR 4.38, 95%CI 1.75-10.96). Most common reasons were patient refusal or individual decision by the treating physician. A metastasized tumor stage was associated with an increased risk of death (HR 2.62, 95%CI 1.45-4.75). In contrast, neither the histological grading (low vs. high) nor age did influence the mortality significantly. Conclusions: In our cohort of STS patients, survival depends significantly on adherence to the recommendations of the ISB. Our analysis at a German sarcoma center is in line with previous international reports demonstrating the importance of interdisciplinary decisions and therapeutic adherence. We hereby underline the essential role of interdisciplinary approaches in care of STS patients and the effort to implement defined quality parameters.

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