Journal of Clinical Oncology, Vol 14, 869-877, Copyright © 1996 by American Society of Clinical Oncology
Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group
JM Coindre, P Terrier, NB Bui, F Bonichon, F Collin, V Le Doussal, AM Mandard, MO Vilain, J Jacquemier, H Duplay, X Sastre, C Barlier, M Henry-Amar, J Mace- Lesech and G Contesso
French Federation of Cancer Centers Sarcoma Group, Paris, France.
PURPOSE: To define the prognostic factors in adult patients with locally
controlled soft tissue sarcoma (STS) and to determine which patients should
be considered for adjuvant treatment. PATIENTS AND METHODS: Five hundred
forty-six patients with a nonmetastatic and locally controlled STS,
collected in a cooperative data base by the French Federation of Cancer
Centers (FNCLCC) Sarcoma Group from 1980 and 1989, were studied. Histologic
slides of all patients were collegially reviewed. Initial treatment
consisted of complete tumor resection with amputation in only 4% of the
patients. Adjuvant radiotherapy was administered to 57.9% and adjuvant
chemotherapy to 31%. Relationships between tumor characteristics were
analyzed, and univariate and multivariate analyses were performed using Cox
models for the hazards rate of tumor mortality, development of distant
metastasis, and strictly local recurrence. RESULTS: Unfavorable
characteristics with an independent prognostic value for tumor mortality
were: grade 3 (P = 3 x 10(-10)), male sex (P = 1.5 x 10(-5)), no adjuvant
chemotherapy (P = 5.4 x 10(-5)), tumor size > or = 5 cm (P = 3.8 x
10(-3)), and deep location (P = 4.6 x 10(-3)). Unfavorable characteristics
for the development of distant metastasis were: grade 3 (P = 4 x 10(-12)),
no adjuvant chemotherapy (P = 6.4 x 10(-4)), tumor size > or = 10 cm (P
= 9.8 x 10(-4)), and deep location (P = 1.3 x 10(- 3)). For the development
of local recurrence, the unfavorable characteristics were: no adjuvant
radiotherapy (P = 3.6 x 10(-6)), poor surgery (local excision) (P = 2 x
10(-4)), grade 3 (P = 7.6 x 10(-4)), and deep location (P = 10(-2)). Grade,
depth, and tumor size were used to define groups of patients according to
the metastatic risk. Adjuvant chemotherapy was beneficial in terms of
overall survival and metastasis- free survival in grade 3 tumor patients
only. Despite worse characteristics concerning tumor depth,
tumor-node-metastasis (TNM) and American Joint Committee
(AJC)/International Union Against Cancer (UICC) classifications and grade
in patients with adjuvant radiotherapy, the latter experienced
significantly fewer local recurrences than patients with no radiotherapy.
CONCLUSION: Grade, tumor depth, and tumor size could be used to select
patients with a high metastatic risk, for which adjuvant chemotherapy could
be beneficial.
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