Abstract 746P
Background
Whether AC improves overall survival (OS) in pts with localized STS is debated. We assessed the impact of AC & NAC on OS of localized STS pts treated in France (2012-2017) using the entire national health data system.
Methods
The DEEPSARC project matched the NETSARC+ database with the health records of all French citizens (Social Security,SNDS). The impact of AC/NAC on OS was assessed by both crude and adjusted analyses, using 3 methods: adjustment on confusion variables, propensity score and instrumental variable method. We analysed 1) the entire N=8331 pts series and 2) the N=4,296 pts series w/ all confounders documented (age, sex, histotype, T size, depth, grade, R, comorbidities,..).
Results
In the entire series of 8331 pts, median age was 65, with 55% men. The 3 main histotypes were LPS (28%), UPS (25%) & LMS (16%). Overall, N=667 (8.0%) & N=676 (8.1%) of pts received AC only or NAC (+AC in N=109) respectively. With a median follow-up (F-up) of 5.8 years, 5-yr OS was 61% (95%CI: 60%-63%). OS was worse in pts receiving AC (5-year OS: 50% [95%CI: 47%-54%] vs 63% [95%CI: 61%-64%]) for pts not receiving AC. In the adjusted analysis (4296 pts), 5-yr OS was 64% (95%CI: 63%-66%). AC was associated with worse 5-y OS: 53% (95%CI:48%-59%) vs 65%.(95%CI: 64%-67%). In multivariate analysis, integrating confounders incl quality of surgery, AC was associated with worse 5-y OS (HR=1.48 [1.12-1.95]) with classical adjustment model, HR=1.49 [1.12-1.98] with propensity score method; HR=1.49 [1.11-2.09] with instrumental variable method), in the whole series,iand also in all histotypes, & in SARCULATOR high-risk pts (10-year pr-OS<60%) (PMID 35224688) (All p values<0.001). NAC was not associated with a better OS (HR= 1.34; 95%CI:1.04-1.73) in this series, in any subgroups (age, sex, histo, high-risk (Grade 3 & size>5 cm), in pts with inclusion criteria of ISG-STS-1001 (PMID 32421444), in high risk SARCULATOR pts,.
Conclusions
In this nationwide real-life study over 5 years, despite adjustment to known STS prognostic factors, neither AC nor NAC were associated with better OS, even in subgroups previously identified as benefiting from AC or NAC. New prospective randomized trials & risk fractors are needed.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Centre Leon Berard.
Funding
INCA, ANR, European Commission.
Disclosure
J. Blay: Financial Interests, Institutional, Funding, NETSARC+: INCa; Financial Interests, Institutional, Funding, INTERSARC+: INCA; Financial Interests, Institutional, Funding, EURACAN: European Commision; Financial Interests, Institutional, Funding, DEEPSARC: HDH ANR. All other authors have declared no conflicts of interest.