Abstract 122P
Background
Soft tissue sarcomas (STS) are rare, heterogeneous malignancies requiring prognostic tools to guide treatment. Sarculator is a validated nomogram for predicting overall survival (OS) and recurrence risk in resected STS. However, data validating its performance outside its initial cohorts are limited. This study evaluates Sarculator’s predictive performance and utility for risk stratification in patients treated with neoadjuvant or adjuvant ifosfamide-epirubicin chemotherapy (CT).
Methods
We retrospectively analyzed 62 STS patients treated with (neo)adjuvant CT at our center (2014–2023). Of these, 32 received neoadjuvant and 30 adjuvant CT. Patient demographics, tumor characteristics, treatments, and outcomes were reviewed. Sarculator-predicted OS was calculated and compared with actual OS at 5 years. Kaplan-Meier survival analyses and log-rank tests evaluated risk groups and survival outcomes.
Results
Median age was 48 years (16–76). Median tumor size was 10 cm; 93.5% presented tumors >5 cm. High-grade tumors (77.4%) predominated. Neurovascular and bone invasion were observed in 38.7% and 12.9%, respectively. Most tumors were in extremities (67.7%) and trunk (21%). 79% receive the expected three cycles of CT. Complete resections (R0) were achieved in 78.5%, while R1 and R2 resections occurred in 12.9% and 9.7%, respectively. 72.6% received (neo)adjuvant radiotherapy. At a median follow-up of 73 months, 58.1% of patients remained disease-free. Recurrence occurred in 41.9% (distant 50%, local 34.6%, combined 15.4%). Five-year OS was 70.8%, comparable to Sarculator's predicted OS of 71%. Stratified by Sarculator, high-risk patients exhibited worse outcomes (OS: 65.9% vs. 77.2%). Risk factors associated with worse OS included high grade (p=0.01), histology (p=0.01), positive margins (R1/R2, p=0.01), retroperitoneal location (p=0.001), relapses (p=0.001). Poor chemotherapy response also correlated with lower OS (p=0.001).
Conclusions
Sarculator effectively stratifies risk in STS patients receiving multimodal treatment. Predicted OS closely mirrored observed outcomes, supporting its integration into clinical decision-making. Further studies incorporating molecular markers may enhance prognostic accuracy.
Clinical trial identification
Editorial acknowledgement
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Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.