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PRIMARY EXTREMITY STS: MULTIMODAL APPROACH MAY HAVE IMPROVED SURVIVAL OVER TIME

PRIMARY EXTREMITY STS: MULTIMODAL APPROACH MAY HAVE IMPROVED SURVIVAL OVER TIME Berselli M, Fiore M, Grosso F, Bertulli B, Collini P, Lozza L, Stacchiotti S, Pennacchioli E, Casali PG & Gronchi A. 1982 - 2009 5641 pts. 1987 - 2007 3607 pts Localized 2863 Extremity 1962

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PRIMARY EXTREMITY STS: MULTIMODAL APPROACH MAY HAVE IMPROVED SURVIVAL OVER TIME

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  1. PRIMARY EXTREMITY STS: MULTIMODAL APPROACH MAY HAVE IMPROVED SURVIVAL OVER TIME Berselli M, Fiore M, Grosso F, Bertulli B, Collini P, Lozza L, Stacchiotti S, Pennacchioli E, Casali PG & Gronchi A

  2. 1982 - 2009 5641pts

  3. 1987 - 2007 3607pts Localized2863 Extremity1962 Retroperitoneum394 Trunkwall262 Head & Neck75 Visceral133 Other37

  4. 1987 - 2007 3607 pts Localized 2863 Extremity1962 Retroperitoneum 394 Trunkwall 262 Head & Neck 75 Visceral 133 Other 37

  5. Excluded from the analysis: • DFSP • WD liposa • Desmoids

  6. Excluded from the analysis: • Localrecurrences • when first seen

  7. 1987 - 2007 1094pts 1987-1991192 1992-1997252 1998-2002 274 2003-2007 376

  8. Prognostic factorsunchanging over time • Age & gender • Mediansize • Site oforigin • Histologicaltype • Qualityofsurgicalmargins

  9. Prognostic factorschanging over time • Depth • more deeptumors in the 1st and 2ndperiod • (91%  91%  68%  63%) • Grade • more G3 tumors in the 1stperiod • (70%  47%  38%  50%)

  10. Treatment criteriachanging over time • Amputations • decreasedfrom the 1stto the 4thperiod • (9%  3%  1%  1%) • Concurrentchemo-radiationtherapy • preoperatively, confinedto the 4thperiod • (0  0  2%  12%) • Peri-operativechemotherapy • increased in the 4thperiod • (23%  13%  22%  32%)

  11. Local recurrence Gray test p<0.0001

  12. Factor HR 95% CI Wald test p Period 1987-1991 vs 2003-2007 2.85 (1.50,5.39) 0.0013 1992-1997 vs 2003-2007 3.19 (1.76,5.78) 1998-2002 vs 2003-200 1.86 (1.02,3.40) Age 64 vs 36 1.79 (1.26,2.54) 0.0051 Size 10 vs 3 1.37 (0.86,2.16) 0.2608 Depth Deep vs Superficial 1.21 (0.68,2.15) 0.5164 Margins Positive vs Negative 2.58 (1.67,3.99) <0.0001 Histotype Other vs MFH 0.45 (0.23,0.85) 0.0958 Leiomyosarcoma vs MFH 0.53 (0.29,0.96) Dediff Liposarcoma vs MFH 0.61 (0.27,1.37) Myxoid/RC Liposarcoma vs MFH 0.52 (0.26,1.02) MPNST vs MFH 0.75 (0.38,1.48) Synovial sarcoma vs MFH 0.96 (0.51,1.80) Vascular sarcoma vs MFH 1.25 (0.44,3.58) Grading II vs I 1.61 (0.89,2.92) 0.1794 III vs I 1.18 (0.63,2.21) CT pre/post Y vs N 1.36 (0.83,2.23) 0.2226 RT pre/post Y vs N 0.73 (0.49,1.09) 0.1258

  13. Overall survival Gray test p=0.0012 Log-rank test p=0.0003

  14. Sarcoma-specific mortality Gray test p=0.0012

  15. Factor HR 95% CI Wald test p Period 1987-1991 vs 2003-2007 1.61 (0.95, 2.74) 0.0011 1992-1997 vs 2003-2007 2.16 (1.31, 3.57) 1998-2002 vs 2003-200 2.45 (1.53, 3.92) Age 64 vs 36 1.18 (0.90, 1.55) 0.4994 Size 10 vs 3 2.62 (1.76, 3.91) <.0001 Depth Deep vs Superficial 1.85 (1.00, 3.44) 0.0504 Margins Positive vs Negative 1.58 (1.09, 2.29) 0.0159 Histotype Other vs MFH 2.01 (1.15, 3.53) <0.0001 Leiomyosarcoma vs MFH 2.99 (1.77, 5.06) Dediff Liposarcoma vs MFH 1.82 (0.90, 3.67) Myxoid/RC Liposarcoma vs MFH 1.42 (0.72, 2.81) MPNST vs MFH 2.63 (1.43, 4.84) Synovial sarcoma vs MFH 3.83 (2.19, 6.69) Vascular sarcoma vs MFH 6.77 (2.84,16.14) Grading II vs I 3.53 (1.73, 7.19) <0.0001 III vs I 5.89 (2.91,11.95) CT pre/post Y vs N 1.22 (0.87, 1.72) 0.2544 RT pre/post Y vs No 0.86 (0.63, 1.18) 0.3490

  16. OS

  17. death due to local disease local recurrences

  18. Sarcoma-specific mortality – G3 Gray test p=0.09 34% 29% 26% 15%

  19. Metastasis-free survival

  20. Post-metastasis survival

  21. …….

  22. Local control has definetely improved, while preoperative chemo-radiation therapy was the main change in treatment Overall survival at 5 yrs has improved, while possibly less patients died of local relapse and distant metastases slightly lowered Post-metastasis duration of survival has improved, while medical therapy became more histology-driven (and something which could be called ‘over-treatment’ in the advanced disease was on the rise) At INT, Milan, over the years…

  23. alessandro.gronchi@istitutotumori.mi.it patrizia.olmi@istitutotumori.mi.it paolo.casali@istitutotumori.mi.it

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