Abstract
Background
Non-gastrointestinal stromal tumor sarcomas (NGSs) have heterogeneous histology, and this heterogeneity may lead to uncertainty regarding the prognosis of patients with liver metastases from NGS (NGSLM) and decision regarding their surgical management. Furthermore, the role of preoperative chemotherapy in treatment of NGSLM remains poorly defined. We investigated long-term survival and its correlation to response to preoperative chemotherapy in patients with NGSLM.
Patients and Method
Patients who underwent liver resection for NGSLM during 1998–2015 were identified. Clinical, histopathologic, and survival data were analyzed. Multivariate analysis was performed using a Cox proportional hazards model.
Results
126 patients [62 (49%) with leiomyosarcoma] were included. Five-year overall survival (OS) and recurrence-free survival (RFS) rates were 49.3 and 14.9%, respectively. Survival did not differ by histologic subtype, primary tumor location, or use of preoperative or postoperative chemotherapy. NGSLM ≥ 10 cm and extrahepatic metastases at NGSLM diagnosis were the only independent risk factors for OS. In the 83 (66%) patients with metachronous NSGLM, disease-free interval > 6 months was associated with improved OS and RFS. Among the 65 patients (52%) who received preoperative chemotherapy, radiologic response according to Choi criteria specifically was associated with improved OS (p = 0.04), but radiologic response according to RECIST 1.1 criteria was not.
Conclusions
Resection of NGSLM led to a 5-year OS rate of 49%, independent of histologic subtype and primary tumor location. Choi criteria (which take into account tumor density) are superior to RECIST 1.1 in assessing radiologic response and should be used to assess response to preoperative chemotherapy.
Similar content being viewed by others
References
Passot G, Soubrane O, Giuliante F, Zimmitti G, Goere D, Yamashita S, et al. Recent advances in chemotherapy and surgery for colorectal liver metastases. Liver Cancer. 2016;6(1):72–9.
Pisters PW, Patel SR. Gastrointestinal stromal tumors: current management. J Surg Oncol. 2010;102(5):530–8.
Turley RS, Peng PD, Reddy SK, Barbas AS, Geller DA, Marsh JW, et al. Hepatic resection for metastatic gastrointestinal stromal tumors in the tyrosine kinase inhibitor era. Cancer. 2012;118(14):3571–8.
Doyle LA. Sarcoma classification: an update based on the 2013 World Health Organization Classification of Tumors of Soft Tissue and Bone. Cancer. 2014;120(12):1763–74.
Jo VY, Doyle LA. Refinements in sarcoma classification in the current 2013 World Health Organization classification of tumours of soft tissue and bone. Surg Oncol Clin N Am. 2016;25(4):621–43.
Vauthey JN, Zimmitti G, Kopetz SE, Shindoh J, Chen SS, Andreou A, et al. RAS mutation status predicts survival and patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases. Ann Surg. 2013;258(4):619–26; discussion 26–7.
Brudvik KW, Patel SH, Roland CL, Conrad C, Torres KE, Hunt KK, et al. Survival after resection of gastrointestinal stromal tumor and sarcoma liver metastases in 146 patients. J Gastroinest Surg. 2015;19(8):1476–83.
Donahue TR, Kattan MW, Nelson SD, Tap WD, Eilber FR, Eilber FC. Evaluation of neoadjuvant therapy and histopathologic response in primary, high-grade retroperitoneal sarcomas using the sarcoma nomogram. Cancer. 2010;116(16):3883–91.
Grunwald V, Litiere S, Young R, Messiou C, Lia M, Wardelmann E, et al. Absence of progression, not extent of tumour shrinkage, defines prognosis in soft-tissue sarcoma—an analysis of the EORTC 62012 study of the EORTC STBSG. Eur J Cancer (Oxford, England). 2016;64:44–51.
Choi H. Role of imaging in response assessment and individualised treatment for sarcomas. Clin Oncol. 2017.
Taieb S, Saada-Bouzid E, Tresch E, Ryckewaert T, Bompas E, Italiano A, et al. Comparison of response evaluation criteria in solid tumours and Choi criteria for response evaluation in patients with advanced soft tissue sarcoma treated with trabectedin: a retrospective analysis. Eur J Cancer (Oxford, England). 2015;51(2):202–9.
Stacchiotti S, Verderio P, Messina A, Morosi C, Collini P, Llombart-Bosch A, et al. Tumor response assessment by modified Choi criteria in localized high-risk soft tissue sarcoma treated with chemotherapy. Cancer. 2012;118(23):5857–66.
Shah D, Borys D, Martinez SR, Li CS, Tamurian RM, Bold RJ, et al. Complete pathologic response to neoadjuvant radiotherapy is predictive of oncological outcome in patients with soft tissue sarcoma. Anticancer Res. 2012;32(9):3911–5.
Blay JY, van Glabbeke M, Verweij J, van Oosterom AT, Le Cesne A, Oosterhuis JW, et al. Advanced soft-tissue sarcoma: a disease that is potentially curable for a subset of patients treated with chemotherapy. Eur J Cancer (Oxford, England). 2003;39(1):64–9.
Mullen JT, Hornicek FJ, Harmon DC, Raskin KA, Chen YL, Szymonifka J, et al. Prognostic significance of treatment-induced pathologic necrosis in extremity and truncal soft tissue sarcoma after neoadjuvant chemoradiotherapy. Cancer. 2014;120(23):3676–82.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.
Adam R, de Gramont A, Figueras J, Kokudo N, Kunstlinger F, Loyer E, et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treatment Rev. 2015;41(9):729–41.
Aloia TA, Zorzi D, Abdalla EK, Vauthey JN. Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection. Ann Surg. 2005;242(2):172–7.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer (Oxford, England). 2009;45(2):228–47.
Therasse P, Le Cesne A, Van Glabbeke M, Verweij J, Judson I. RECIST vs. WHO: prospective comparison of response criteria in an EORTC phase II clinical trial investigating ET-743 in advanced soft tissue sarcoma. Eur J Cancer (Oxford, England). 2005;41(10):1426–30.
Wardelmann E, Haas RL, Bovee JV, Terrier P, Lazar A, Messiou C, et al. Evaluation of response after neoadjuvant treatment in soft tissue sarcomas; the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG) recommendations for pathological examination and reporting. Eur J Cancer (Oxford, England). 2016;53:84–95.
Blazer DG, 3rd, Kishi Y, Maru DM, Kopetz S, Chun YS, Overman MJ, et al. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol. 2008;26(33):5344–51.
DeMatteo RP, Shah A, Fong Y, Jarnagin WR, Blumgart LH, Brennan MF. Results of hepatic resection for sarcoma metastatic to liver. Ann Surg. 2001;234(4):540–7; discussion 7–8.
Elias D, Cavalcanti de Albuquerque A, Eggenspieler P, Plaud B, Ducreux M, Spielmann M, et al. Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg. 1998;187(5):487–93.
Fitzgerald TL, Brinkley J, Banks S, Vohra N, Englert ZP, Zervos EE. The benefits of liver resection for non-colorectal, non-neuroendocrine liver metastases: a systematic review. Langenbeck Arch Surg. 2014;399(8):989–1000.
Groeschl RT, Nachmany I, Steel JL, Reddy SK, Glazer ES, de Jong MC, et al. Hepatectomy for noncolorectal non-neuroendocrine metastatic cancer: a multi-institutional analysis. J Am Coll Surg. 2012;214(5):769–77.
Marudanayagam R, Sandhu B, Perera MT, Bramhall SR, Mayer D, Buckels JA, et al. Liver resection for metastatic soft tissue sarcoma: an analysis of prognostic factors. Eur J Surg Oncol. 2011;37(1):87–92.
Neri F, Ercolani G, Di Gioia P, Del Gaudio M, Pinna AD. Liver metastases from non-gastrointestinal non-neuroendocrine tumours: review of the literature. Updates Surg. 2015;67(3):223–33.
Page AJ, Weiss MJ, Pawlik TM. Surgical management of noncolorectal cancer liver metastases. Cancer. 2014;120(20):3111–21.
Pawlik TM, Vauthey JN, Abdalla EK, Pollock RE, Ellis LM, Curley SA. Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg. 2006;141(6):537–43; discussion 43–4.
Rehders A, Peiper M, Stoecklein NH, Alexander A, Boelke E, Knoefel WT, et al. Hepatic metastasectomy for soft-tissue sarcomas: is it justified? World J Surg. 2009;33(1):111–7.
Zhang F, Wang J. Clinical features of surgical resection for liver metastasis from extremity soft tissue sarcoma. Hepato-gastroenterol. 2015;62(139):677–82.
Gutierrez JC, Perez EA, Franceschi D, Moffat FL, Jr., Livingstone AS, Koniaris LG. Outcomes for soft-tissue sarcoma in 8249 cases from a large state cancer registry. J Surg Res. 2007;141(1):105–14.
Italiano A, Mathoulin-Pelissier S, Cesne AL, Terrier P, Bonvalot S, Collin F, et al. Trends in survival for patients with metastatic soft-tissue sarcoma. Cancer. 2011;117(5):1049–54.
Eilber FC, Rosen G, Eckardt J, Forscher C, Nelson SD, Selch M, et al. Treatment-induced pathologic necrosis: a predictor of local recurrence and survival in patients receiving neoadjuvant therapy for high-grade extremity soft tissue sarcomas. J Clin Oncol 2001;19(13):3203–9.
Jaques DP, Coit DG, Casper ES, Brennan MF. Hepatic metastases from soft-tissue sarcoma. Ann Surg. 1995;221(4):392–7.
Stacchiotti S, Collini P, Messina A, Morosi C, Barisella M, Bertulli R, et al. High-grade soft-tissue sarcomas: tumor response assessment–pilot study to assess the correlation between radiologic and pathologic response by using RECIST and Choi criteria. Radiology. 2009;251(2):447–56.
Mir O, Brodowicz T, Italiano A, Wallet J, Blay JY, Bertucci F, et al. Safety and efficacy of regorafenib in patients with advanced soft tissue sarcoma (REGOSARC): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Oncol. 2016;17(12):1732–42.
Disclosure
None of the authors have declared any conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Goumard, C., Marcal, L.P., Wang, WL. et al. Long-Term Survival According to Histology and Radiologic Response to Preoperative Chemotherapy in 126 Patients Undergoing Resection of Non-GIST Sarcoma Liver Metastases. Ann Surg Oncol 25, 107–116 (2018). https://doi.org/10.1245/s10434-017-6144-4
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-017-6144-4