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Soft tissue sarcoma prognosis correlates with mitotic count, amount of viable tumor after neoadjuvant treatment
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Because response assessment after neoadjuvant therapy is not yet standardized for patients with localized, high-grade soft tissue sarcoma, investigators researched tumor response following two kinds of neoadjuvant treatment and found mitotic count and the amount of viable tumor were factors that correlated with tumor prognosis.
Dimosthenis Andreou, MD, is scheduled to present the results of the single-center retrospective study at next month’s EFORT Congress in London.
Andreou told Orthopaedics Today Europe he and his colleagues were interested in finding any differences in disease-specific survival (DSS) and event-free survival (EFS) in the study cohort based on mitotic count (MC) and the amount of viable tumor (VT).
“Our results are promising. Our study shows that the mitotic count after treatment can be used to separate patients into distinct prognostic groups,” Andreou said.
From 2001 to 2011, a total of 118 patients underwent the combined treatment approach of neoadjuvant regional chemotherapy (isolated limb perfusion ILP; 61 patients) or systemic chemotherapy (SC; 57 patients) followed up with surgical resection with intent to cure their localized, high-grade soft tissue sarcomas.
Median follow-up was 44 months in all patients and 56 months in survivors. The findings were based on the analysis of sarcoma specimens obtained during surgical resection done after either SC or ILP.
The investigators found that when the amount of VT was less than 10% following SC, patients had a 94% DSS at 5 years. The DSS was 61% at 5 years when the amount of VT was equal to or higher than 10% in these patients.
DSS and EFS did not correlate, however, with the amount of VT after ILP, according to the results.
The MC results showed a significantly lower DSS and EFS in patients after SC with an MC that was equal to or higher than 20/10 high power fields (HPF) compared to that in patients with a MC less than 20/10 HPF. In patients with a lower MC, the DSS was 84% at 5 years compared to a DSS of 33% in patients with a higher MC.
“Following ILP the survival benefit was more pronounced for patients with a MC less than 10/10 HPF who had a significantly higher DSS and EFS than patients with a MC equal to or higher than 10/10 HPF,” Andreou and colleagues wrote.
Andreou said, “For patients with isolated limb perfusion, we found the MC was a means to discriminate between patients with a good and patients with a poor prognosis.”
These findings must be interpreted correctly, he said, noting different chemotherapy plans could lead to a different correlation between mitotic count and prognosis. The vast majority of samples the investigators assessed were from undifferentiated sarcomas. – by Susan M. Rapp
- Reference:
- Andreou D. Paper #14-336; Scheduled to be presented June 6 at: 15th EFORT Congress – A Combined Program in Partnership With the BOA; June 4-6, 2014; London.
- For more information:
- Dimosthenis Andreou, MD, can be reached at Münster University Hospital, Albert-Schweizer-Str. 33, 48149 Münster, Germany; email: dimosthenis.andreou@ukmuenster.de.
Disclosure: Andreou has no relevant financial disclosures.