Tumour necrosis following chemotherapy is prognostic in bone sarcoma, but remains undefined in STS.
We searched MEDLINE, MEDLINE in progress, EMBASE and Cochrane to identify studies that investigated neoadjuvant therapy in STS. Eligible studies were required to have data on survival outcomes based on tumor necrosis in the resected specimen, or provided individual patient data. Hazard ratios (HR) for relapse free (RFS) and overall survival (OS) as well as odds ratios (OR) for recurrence at 3 years and for death at 5 years were pooled in a random effect meta-analysis. Association between patient characteristics and attainment of ≥ 90% necrosis were explored with logistic regression.
21 studies comprising 1644 patients were included in this analysis. Location of the tumor included the extremities in the majority (n = 1459; 89%). Induction regimens included chemotherapy/radiation (n = 813; 49%), chemotherapy alone (n = 418; 25%), chemotherapy/caffeine (n = 81; 5%), radiotherapy alone (n = 78; 5%), isolated limb perfusion (ILP) with (n = 28; 2%) or without radiation (n = 208; 13%), and targeted therapy/radiotherapy (n = 18; 1%). Utilizing a cut-off of 90%, patients with ≥ 90% tumour necrosis had significantly reduced risk of recurrence at 3 years (OR0.30; 95% CI: 0.20-0.44; p
Tumour necrosis ≥ 90% following neoadjuvant therapy is associated with reduced recurrence risk and improved overall survival in patients with STS.
Clinical trial identification
Legal entity responsible for the study
Princess Margaret Cancer Centre
All authors have declared no conflicts of interest.