Connective Tissue Oncology Society 15th Annual Meeting Miami, November 5-7th 2009
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Transcript of Connective Tissue Oncology Society 15th Annual Meeting Miami, November 5-7th 2009
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Connective Tissue Oncology Society
15th Annual MeetingMiami, November 5-7th 2009
HISTOLOGY-SPECIFIC NOMOGRAM FOR PATIENTS AFFECTED BY
PRIMARY RSTS
Alessandro [email protected]
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Prognostication
• a duty for the clinician
– for taking decision on • Complementary treatments• Post-operative surveillance
– for informing the patient
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Background
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288 pts
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122 pts
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268 pts
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268 pts
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Methods
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5641 pts, collected from 1982 to 2009
Institutional STS DB
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INT 1985 - 2007
• Localized STS 3085
• Extremity 2043
• Retroperitoneum 396
• Trunk wall 273
• Head & Neck 76
• Visceral 112
• Other 185
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We excluded…
Local recurrence at presentation
Pediatric histologies (pPNET…)
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Parameters investigated
• Age
• Size
• Histotype– Liposarcoma– Leiomiosarcoma– MPNST– SFT– Other
• Grade
• Completeness of surgical resection (Y/N)Gronchi et al Cancer 2004; 100: 2448-2455
Gronchi et al J Clin Oncol 2009; 27(1): 24-30
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Statistical methods
• End point was OS at 5 and 10 yrs.
• Piecewise Regression Model (instead of the usual Cox Model).
• Age and size were modelled as continuous variables.
• Model performance evaluated through discriminating ability and calibration assessments.
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Results
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198 patients• Gender
– Male 99– Female 93
• Median age 55 (17-80)
• Median size 16 (4-75)
• Completeness of resection (y/n) 178/14
GIII
GII
GI
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Survival at 5 and 10 years (+ 95% CI)
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β SE HR 95% CI
Age*
55 vs 43 years66 vs 55 years
0.02 0.0101.251.23
(0.99, 1.58)(0.99, 1.52)
Tumour SizeLinearNon linear20 vs 10 cm30 vs 20 cm
0.09-0.12
0.0410.053
1.781.02
(1.08, 3.11)(0.95, 1.04)
Histological SubtypeLeiomyiosarcoma vs LiposarcomaSFT vs LiposarcomaMPNST vs LiposarcomaOther vs Liposarcoma
-0.46-1.79-0.220.45
0.3741.0290.4670.406
0.630.170.801.58
(0.30, 1.30)(0.02, 1.24)(0.32, 1.99)(0.71, 3.49)
GradingII vs IIII vs I
1.202.05
0.3910.377
3.327.74
(1.54, 7.14)(3.70, 16.2)
Surgical MarginsMacro (R2) vs Micro (R0/R1) 1.43 0.364 4.18 (2.05, 8.54)
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…liposarcoma rarely get cured…
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Log-Relative hazard of death for all causes according to tumour size from the
piecewise regression model.
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…our nomogram…
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Model performancePredictive performance: adjusted C Index=0.73 (satisfactory accuracy)
Calibration plots: predicted and observed survival probabilities in good agreement.
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We do have now different tools…
Which one should we choose ?
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INT - Milan
MDACC - Houston
MSKCC - NY
MSKCC - NY
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GI 75% 85% 85% 80%
GII 40% _ _ 40%
GIII 10% 55% 46% 10%
60 yr 25 cm
5 yr OS
GI 65% _ 63% 60%
GII 15% _ _ 15%
GIII 0% _ 27% 0%
10 yr OS
Liposarcoma
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GI 80% _ 80% _
GII 50% 45% _ _
GIII 15% _ 33% _
5 yr OS
GI 65% _ 52% _
GII 35% _ _ _
GIII 0% _ 16% _
10 yr OS
60 yr 25 cm
Leiomyosarcoma
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GI 80% _ 64% _
GII 35% 45% _ _
GIII 0% _ 12% _
5 yr OS
GI 65% _ 28% _
GII 20% _ _ _
GIII 0% _ 3% _
10 yr OS
60 yr 25 cm
MPNST
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GI 95% _ 78% _
GII _ 45% _ _
GIII 68% _ 30% _
5 yr OS
GI 90% _ 49% _
GII _ _ _ _
GIII 45% _ 13% _
10 yr OS
60 yr 25 cm
SFT
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Conclusions
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• Different nomograms for RSTS are available
• They seem to be quite consistent in the prediction of liposarcoma’s outcome (the commonest histology).
• Wy tried to improve the available nomograms by:– using size as a continuous variable (and age…)
– introducing the histological subtype more frequently found at this site
– complementing histological subtype by histological grade of aggressiveness (a 3-tier grade according to FNCLCC)
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…next step…
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INT - Milan
MDACC - Houston
•Cross-check comparisons
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MDACC - Houston
INT - Milan
•Call for somebody else in the game for external validation
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•Combine series to come out with a possibly better tool