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Connective Tissue Oncology Society 15th Annual Meeting Miami, November 5-7th 2009

Connective Tissue Oncology Society 15th Annual Meeting Miami, November 5-7th 2009. HISTOLOGY-SPECIFIC NOMOGRAM FOR PATIENTS AFFECTED BY PRIMARY RSTS. Alessandro Gronchi alessandro.gronchi@istitutotumori.mi.it. Prognostication. a duty for the clinician for taking decision on

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Connective Tissue Oncology Society 15th Annual Meeting Miami, November 5-7th 2009

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  1. Connective Tissue Oncology Society 15th Annual Meeting Miami, November 5-7th 2009 HISTOLOGY-SPECIFIC NOMOGRAM FOR PATIENTS AFFECTED BY PRIMARY RSTS Alessandro Gronchi alessandro.gronchi@istitutotumori.mi.it

  2. Prognostication • a duty for the clinician • for taking decision on • Complementary treatments • Post-operative surveillance • for informing the patient

  3. Background

  4. 288 pts

  5. 122 pts

  6. 268 pts

  7. 268 pts

  8. Methods

  9. 5641 pts, collected from 1982 to 2009 Institutional STS DB

  10. INT 1985 - 2007 • Localized STS 3085 • Extremity 2043 • Retroperitoneum 396 • Trunk wall 273 • Head & Neck 76 • Visceral 112 • Other 185

  11. We excluded… Local recurrence at presentation Pediatric histologies (pPNET…)

  12. 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

  13. 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.

  14. Results

  15. 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 GI GII

  16. Survival at 5 and 10 years (+ 95% CI)

  17. …liposarcoma rarely get cured…

  18. Log-Relative hazard of death for all causes according to tumour size from thepiecewise regression model.

  19. …our nomogram…

  20. Model performance Predictive performance: adjusted C Index=0.73 (satisfactory accuracy) Calibration plots: predicted and observed survival probabilities in good agreement.

  21. We do have now different tools…Which one should we choose ?

  22. INT - Milan MDACC - Houston MSKCC - NY MSKCC - NY

  23. Liposarcoma 60 yr 25 cm GI 75%85%85%80% GII 40%__40% GIII 10%55%46%10% 10 yr OS 5 yr OS GI 65%_63%60% GII 15%__15% GIII 0%_27%0%

  24. Leiomyosarcoma 60 yr 25 cm GI 80%_80%_ GII 50%45%__ GIII 15%_33%_ 10 yr OS 5 yr OS GI 65%_52%_ GII 35%___ GIII 0%_16%_

  25. MPNST 60 yr 25 cm GI 80%_64%_ GII 35%45%__ GIII 0%_12%_ 10 yr OS 5 yr OS GI 65%_28%_ GII 20%___ GIII 0%_3%_

  26. SFT 60 yr 25 cm GI 95%_78%_ GII _45%__ GIII 68%_30%_ 10 yr OS 5 yr OS GI 90%_49%_ GII ____ GIII 45%_13%_

  27. Conclusions

  28. 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)

  29. …next step…

  30. Cross-check comparisons INT - Milan MDACC - Houston

  31. Call for somebody else in the game for external validation MDACC - Houston INT - Milan

  32. Combine series to come out with a possibly better tool

  33. alessandro.gronchi@istitutotumori.mi.it

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