Neoadjuvant Chemotherapy in Retroperitoneal Sarcoma: A National Cohort Study
Introduction Management of retroperitoneal sarcoma (RPS) remains controversial, with the mainstay of treatment being surgery. While neoadjuvant radiation demonstrated no improvement in recurrence-free survival in a prospective randomized trial (STRASS), the role of neoadjuvant chemotherapy (NCT) rem...
Saved in:
Published in | Annals of surgical oncology Vol. 30; no. 11; pp. 6886 - 6893 |
---|---|
Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Cham
Springer International Publishing
01.10.2023
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
ISSN | 1068-9265 1534-4681 1534-4681 |
DOI | 10.1245/s10434-023-13933-2 |
Cover
Summary: | Introduction
Management of retroperitoneal sarcoma (RPS) remains controversial, with the mainstay of treatment being surgery. While neoadjuvant radiation demonstrated no improvement in recurrence-free survival in a prospective randomized trial (STRASS), the role of neoadjuvant chemotherapy (NCT) remains unknown and is the subject of ongoing study (STRASS2).
Methods
Patients who underwent surgical resection of high-grade RP leiomyosarcoma (LMS) or dedifferentiated liposarcoma (DDLS) were identified from the National Cancer Database (2006–2019). Predictors of NCT were analyzed using univariate and multivariate logistic regression analyses. Differences in 5-year survival were examined using the Kaplan–Meier (KM) method and by Cox proportional hazard modeling.
Results
A total of 2656 patients met inclusion criteria. Fifty-seven percent of patients had DDLS and 43.5% had LMS. Six percent of patients underwent NCT. Patients who received NCT were younger (median age 60 vs 64 years,
p
< 0.001) and more likely to have LMS (OR 1.4,
p
= 0.04). In comparing NCT with no-NCT patients, there was no difference in 5-year overall survival (OS) on KM analysis (57.3% vs 52.8%,
p
= 0.38), nor was any difference seen after propensity matching (54.9% vs 49.1%,
p
= 0.48,
N
= 144 per group). When stratified by histology, there was no difference in OS based on receipt of NCT (LMS: 59.8% for NCT group, 56.6% for no-NCT,
p
= 0.34; DDLS: 54.2% for NCT group, 50.1% for no-NCT,
p
= 0.99).
Conclusion
In patients undergoing surgical resection of RP LMS or DDLS, NCT does not appear to confer an OS advantage. Prospective randomized data from STRASS2 will confirm or refute these retrospective data. |
---|---|
Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 |
ISSN: | 1068-9265 1534-4681 1534-4681 |
DOI: | 10.1245/s10434-023-13933-2 |