1498P - A prognostic score to guide appropriate delivery of first line palliative chemotherapy for advanced soft tissue sarcoma

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anti-Cancer Agents & Biologic Therapy
Soft Tissue Sarcomas
Presenter Nicholas Gough
Authors N. Gough1, C. Smith2, J.R. Ross2, J. Riley2, I. Judson3
  • 1Palliative Care Department, Royal Marsden Hospital, SW36JJ - London/UK
  • 2Palliative Care, Royal Marsden Hospital, SW36JJ - London/UK
  • 3Sarcoma Unit, Royal Marsden HospitalCR UK Centre for Cancer Therapeutics, GB-SM2 5PT - Sutton/UK

Abstract

Objective

The study investigated predictive variables of overall survival (OS) in patients treated with first line palliative chemotherapy for locally advanced/ metastatic soft tissue sarcoma (STS) from 1998-2008. Poor performance status (PS) has been identified as a powerful risk factor for early death in this population. Establishing additional objective variables may further aid decision making when considering the risk/benefit ratio of systemic chemotherapy.

Methods

Pre-treatment demographic, STS-specific and biochemical variables of 501 patients were reviewed retrospectively. Patients with chemo-sensitive subtypes gastro-intestinal stromal tumour, rhabdomyosarcoma, desmoplatic small round cell tumour were excluded. Significant prognostic factors in univariate analysis were further evaluated using multivariate analysis (Cox regression).

Results

Median OS was 11.4 months, 90-day mortality 17% and the 1, 2 and 5 year survival was 43, 23 and 2% respectively. The Cox model identified age >60 years [Hazard ratio: 1.35 (95% confidence interval 1.01-1.80) p = 0.04], >2 sites of metastases [HR: 1.47 (1.14- 1.90) p =0.003], presence of soft tissue metastases [HR 1.23 (0.99 -1.51) p= 0.054] together with lymphocytes <1 x 109/L [HR 1.63 (1.30-2.04) p <0.001], sodium <135mmol/L [HR 1.52 (1.18- 1.96) p= 0.001] and serum albumin <35g/L [HR 1.89 (1.52-2.35) p < 0.001] as independent prognostic factors for poor OS. A risk score was defined where a point was allocated for each of the above pre-treatment biochemical variables i.e. 0 = normal, 1 = abnormal. Patients scoring 2-3 points (n = 123) had significantly shorter OS than those with 0-1 points (n = 378): 3.1 months (95% CI 2.3-3.7) vs 13.8 months (95% CI 12.6 – 15.2)] p< 0.001. The sensitivity and specificity for predicting 90-day death was 70.2% and 84.6% respectively.

Conclusion

Alongside PS, we propose a simple objective STS-specific score as a further aid to clinical decision making. Patients with a median prognosis of 3 months are unlikely to derive significant benefit from chemotherapy and this needs to be discussed with the patient. This score now needs to be validated prospectively in an independent cohort.

Disclosure

All authors have declared no conflicts of interest.