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Extremity Soft Tissue Sarcoma: A Multi-Institutional Validation of Prognostic Nomograms

  • Sarcoma
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Abstract

Background

Prognostic nomograms for patients with resected extremity soft tissue sarcoma (STS) include the Sarculator and Memorial Sloan Kettering (MSKCC) nomograms. We sought to validate these two nomograms within a large, modern, multi-institutional cohort of resected primary extremity STS patients.

Methods

Resected primary extremity STS patients from 2000 to 2017 were identified across nine high-volume U.S. institutions. Predicted 5- and 10-year overall survival (OS) and distant metastases cumulative incidence (DMCI), and 4-, 8-, and 12-year disease-specific survival (DSS) were calculated with Sarculator and MSKCC nomograms, respectively. Predicted survival probabilities stratified in quintiles were compared in calibration plots to observed survival assessed by Kaplan–Meier estimates. Cumulative incidence was estimated for DMCI. Harrell’s concordance index (C-index) assessed discriminative ability of nomograms.

Results

A total of 1326 patients underwent resection of primary extremity STS. Common histologies included: undifferentiated pleomorphic sarcoma (35%), fibrosarcoma (13%), and leiomyosarcoma (9%). Median tumor size was 8.0 cm (IQR 4.5–13.0). Tumor grade distribution was: Grade 1 (13%), Grade 2 (9%), Grade 3 (78%). Median OS was 172 months, with estimated 5- and 10-year OS of 70% and 58%. C-indices for 5- and 10-year OS (Sarculator) were 0.72 (95% CI 0.70–0.75) and 0.73 (95% CI 0.70–0.75), and 0.72 (95% CI 0.69–0.75) for 5- and 10-year DMCI. C-indices for 4-, 8-, and 12-year DSS (MSKCC) were 0.71 (95% CI 0.68–0.75). Calibration plots showed good prognostication across all outcomes.

Conclusions

Sarculator and MSKCC nomograms demonstrated good prognostic ability for survival and recurrence outcomes in a modern, multi-institutional validation cohort of resected primary extremity STS patients. External validation of these nomograms supports their ongoing incorporation into clinical practice.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Levine Cancer Institute, Atrium Health, Charlotte, NC, USA

    Malcolm Hart Squires MD, Erin E. Donahue PhD, Jennifer H. Benbow PhD, Colin J. Anderson MD, Megan H. Jagosky MD, Joshua C. Patt MD, Jeffrey S. Kneisl MD, Jonathan C. Salo MD, Joshua S. Hill MD, William Ahrens MD, Roshan S. Prabhu MD, Michael B. Livingston MD, Nicole L. Gower BS, McKenzie Needham BS & Sally J. Trufan MS

  2. Emory University, Atlanta, GA, USA

    Cecilia G. Ethun MD & Kenneth Cardona MD

  3. Musculoskeletal Institute, Atrium Health, Charlotte, NC, USA

    Colin J. Anderson MD, Joshua C. Patt MD & Jeffrey S. Kneisl MD

  4. University of South Alabama, Mobile, AL, USA

    Munsa Manandhar BA & J. Harrison Howard MD

  5. Washington University School of Medicine, St. Louis, MO, USA

    Ryan C. Fields MD & Bradley A. Krasnick MD

  6. Medical College of Wisconsin, Milwaukee, WI, USA

    Meena Bedi MD

  7. Wake Forest University, Winston Salem, NC, USA

    Konstantinos Votanopoulos MD & Konstantinos Chouliaras MD

  8. The Ohio State University, Columbus, OH, USA

    Valerie Grignol MD

  9. University of Chicago, Chicago, IL, USA

    Kevin K. Roggin MD & Jennifer Tseng MD

  10. Stanford University, Stanford, CA, USA

    George Poultsides MD & Thuy B. Tran MD

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  1. Malcolm Hart Squires MD
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Contributions

MHS, CGE, JHB, CJA, MHJ, JCP, JSK, MBL, NLG, JSH JCS, RSP, KC, and JHH contributed to the conception/design of the work; MHS, CGE, JHB, MM, NLG, MN, WA, RSP, RCF, BAK, MB, KV, KC, VG, KKR, JT, GP, and TT contributed to the acquisition of data; MHS, EED, CJA, MHJ, JCP, JSK, SJT, JCS, KC, JHH contributed to the analysis/interpretation of the data; MHS, JHB, EED, JCS, KC, JHH drafted the manuscript; all authors critically revised the manuscript for intellectual content; all authors approved the final version submitted and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Malcolm Hart Squires MD.

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Squires, M.H., Ethun, C.G., Donahue, E.E. et al. Extremity Soft Tissue Sarcoma: A Multi-Institutional Validation of Prognostic Nomograms. Ann Surg Oncol 29, 3291–3301 (2022). https://doi.org/10.1245/s10434-021-11205-5

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  • DOI: https://doi.org/10.1245/s10434-021-11205-5

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