2818 - Improved survival with secondary surgery in a reference center after a first R1 or R2 resection in soft tissue sarcoma (STS) of the limbs or trunk wall: an analysis 10931 patients (pts) in NETSARC.

Background

We investigated the impact of secondary surgery (2Surg) after a first R1 or R2 resection in the 10931 pts with STS of the limb or trunk wall included in the nationwide NETSARC database from 2010 to 2017.

Methods

NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDT), funded by the French NCI (INCa). Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma pts. Statistics were performed with SPSS23.0. LRFS, metastasis-free survival (MFS), OS compared with the logrank test.

Results

In 5295 (49.4%) patients, sarcoma were located on the lower limb, 3670 (33.6%) on trunk wall, 1966 (18.0%) on upper limb. Local RFS (LRFS) and RFS (p < 0.001), but not OS, were superior for pts operated in a NETSARC center (N = 4417, 41%). LRFS & OS were best for pts presented to a Netsarc MDT (NMDT) AND who were first operated in NETSARC centers; while the worst LRFS & OS were observed in pts presented in a NMDT but first operated outside a NetSARC center (p < 0.001). Among the 2081 pts with a first R1 resection in whom 2Surg was documented, 1047 (50.3%) were reoperated. These R1 reoperated pts had a superior LRFS, metastatic free survival (MFS) and OS (p < 0.001): LRFS (p < 0.001), MFS (p = 0.05) and OS (p < 0.001) were superior after 2Surg only in pts operated 1^st outside a Netsarc center. There were 823 pts with a first surgery with R2 resection in whom 2Surg was documented: 619 (75.2%) were reoperated. R2 reoperated patients had a superior LRFS and OS (p = 0.01). MFS was not different. Again, LRFS (p < 0.001) & OS (p < 0.001) were superior after 2Surg only in pts operated 1^st outside a Netsarc center. Among reoperated pts, those for whom 2Surg was in a NetSARC center had a superior LRFS & RFS (p < 0.001) and OS (p = 0.05).

Conclusions

In this nationwide series of limb or trunk wall STS, 2Surg after a R1 or R2 primary excision was associated with an improved OS only when pts had been operated first outside a reference center. 2Surg in a NETSARC center was associated with a better OS.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Jean-Yves Blay.

Funding

INCA (NetSarc, RREPS, RESOS, LYRICAN (INCA-DGOS-INSERM 12563), ARC fundation, Ligue de L’Ain contre le Cancer, INCA (NetSARC, RREPS, RESOS and LYRICAN (INCA-DGOS-INSERM 12563), InterSARC), La Ligue contre le Cancer, Ligue de L’Ain contre le Cancer, la Fondation ARC, EURACAN (EC 739521).

Disclosure

All authors have declared no conflicts of interest.