CTOS 12th Annual Meeting Venice, 2-4 November 2006
description
Transcript of CTOS 12th Annual Meeting Venice, 2-4 November 2006
![Page 1: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/1.jpg)
CTOS 12th Annual MeetingVenice, 2-4 November 2006
Myxoid/RC Liposarcoma: Prognostic Factors And Survival
Marco [email protected]
![Page 2: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/2.jpg)
Soft Tissue SarcomaINT 1980-2005
N° pz. operated 3026
Liposarcoma 685MFH/Pleomorphic sarcoma 389Leiomiosarcoma 372DFSP 260Aggressive Fibromatosis 240Synovial Sarcoma 224MPNST 222Sarcoma NOS 143 Others 491
23%
![Page 3: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/3.jpg)
WD Liposarcoma 233
Dediff Liposarcoma 123
Myxoid Liposarcoma 202
Round cell Liposarcoma 66
Pleomorphic Liposarcoma 61
685 Liposarcoma INT 1980-2005
48%
![Page 4: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/4.jpg)
FUS/TLS-CHOP t(12;16)(q13;p11) (95%)
FUS/TLS
EWS
CHOP/DDIT3
EWS-CHOP t(12;22)(q13;q12) (5%)
myxoid
round cell
pleomorphic
![Page 5: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/5.jpg)
329 Myxoid/RC Liposarcoma INT 1980-2005
2 1%
15 5%
39 12%
273 83%
Head & Neck
Trunk
Retr./Intrapelvic
Extremities
75%
![Page 6: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/6.jpg)
Median Age 49 yrsMale : Female 1 : 1Median Size 8.5 cmDeep Site 84%Grade (FNCLCC)
I 54%II 23%III 22%
329 Myxoid/RC Liposarcoma INT 1980-2005
![Page 7: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/7.jpg)
Primary Recurrent
Total 214 65% 115 35%
MLPS 132 62% 70 61%
RCLPS 44 21% 22 19%
PLPS 38 18% 23 20%
RTNot Done 130 61% 71 62%
Done 84 39% 44 38%
CTNot Done 175 82% 93 81%
Done 39 18% 22 19%
![Page 8: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/8.jpg)
Primary Recurrent
Total 214 65% 115 35%
Site**Extremities 190 89% 83 72%
Intrabd/RP 16 7% 23 20%
Surgical ProcedureLimb Sparing 177 83% 75 65%
Amputation 5 2% 6 5%
NA (trunk, H&N, RP) 32 15% 34 30%
Surgical Margins**Negative 186 87% 75 65%
Positive 28 13% 40 35%
![Page 9: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/9.jpg)
![Page 10: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/10.jpg)
![Page 11: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/11.jpg)
![Page 12: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/12.jpg)
Prognosis depends on…
![Page 13: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/13.jpg)
•the tumor
![Page 14: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/14.jpg)
Hazard Ratio 95% C. I.
Presentation: Recurrence ( Primary ) 2.781** 1.659 4.661
Depth: Deep ( Superficial ) 1.632** 0.556 4.794
Size : >5 cm ( 5 cm ) 2.161** 0.911 5.124
Site: Extremity ( Other ) 0.580** 0.317 1.062
Grade: II ( I ) 2.356** 1.107 5.013
Grade: III ( I ) 1.853** 0.701 4.899
Histology: PLPS (MLPS ) 0.908** 0.369 2.232
Multivariate Analysis - DSS
![Page 15: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/15.jpg)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1 STS high gradeDFS
Suit HD. J Clin Oncol 1988; 6: 854
<2,5 2,5-5 5-10 10-15 15-20 >20 cm
Size…
![Page 16: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/16.jpg)
Site…
![Page 17: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/17.jpg)
0
0.2
0.4
0.6
0.8
1
0 1 2 3 4 5 6 7 aa
grade 1
grade 2
grade 3
OS
Grading…
![Page 18: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/18.jpg)
Round cell component…
Antonescu CR, Clin Cancer Res 2001;7:3977
RC >5%
![Page 19: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/19.jpg)
![Page 20: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/20.jpg)
Primary: Disease-Specific Survival
Years
0 1 2 3 4 5 6 7 8 9 10
Pro
babi
lity
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
MLPSRCLPSPLPS
0.2217P
214 Primary Myxoid/RC LPS - DSS INT 1980-2005
5-yrs 10-yrs
Overall 90% 87%
MLPS 93% 90%
RCLPS 87% 81%
PLPS 82% 82%
![Page 21: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/21.jpg)
Primary: Crude Cumulative Incidence of Local-Regional Relapse
Years
0 1 2 3 4 5 6 7 8 9 10
Pro
bab
ility
0.0
0.1
0.2
0.3
0.4
0.5
0.6MLPSRCLPSPLPS
0.8907P
214 Primary Myxoid/RC LPS - LR INT 1980-2005
5-yrs 10-yrs
Overall 13% 18%
MLPS 12% 18%
RCLPS 10% 15%
PLPS 19% 19%
![Page 22: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/22.jpg)
Primary: Crude Cumulative Incidence of Distant Metastasis
Years
0 1 2 3 4 5 6 7 8 9 10
Pro
ba
bilit
y
0.0
0.1
0.2
0.3
0.4
0.5
0.6MLPSRCLPSPLPS
0.0018P
214 Primary Myxoid/RC LPS - DM INT 1980-2005
5-yrs 10-yrs
Overall 10% 11%
MLPS 4% 5%
RCLPS 23% 23%
PLPS 20% 20%
p=.0018
![Page 23: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/23.jpg)
Pattern of Distant Mets
41% extra-pulmonary mets
26% lung mets
33% both
• 74% of metastatic patients had at least one extra-pulmonary mets
![Page 24: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/24.jpg)
Extra-pulmonary metastatic pattern according to histological subtype.
MLPS RCLPS PLPS Overall
Intrabdominal 6 4/2 5 3/2 - - 11 7/4
Bone/Spine 6 2/4 3 2/1 - - 9 4/5
Paraspinal 3 0/3 5 2/3 - - 8 2/6
Extremities 4 2/2 3 2/1 1 1/0 8 5/3
Soft tissues 1 0/1 4 3/1 - - 5 3/2
Thoracic wall 3 2/1 2 0/2 - - 5 2/3
Retroperitoneum 3 1/2 1 0/1 - - 4 1/3
Liver 1 1/0 1 0/1 2 2/0 4 3/1
Heart/Pericardium 2 1/1 1 0/1 1 1/0 4 2/2
Mediastinum 2 1/1 2 2/0 - - 4 3/1
Brain - - 1 0/1 1 1/0 2 1/1
Regional nodes 1 0/1 1 0/1 - - 2 0/2
Abdominal wall 1 0/1 - - - - 1 0/1
Overall 33 14/19 29 14/15 5 5/0 67 33/34
Multiple extra-pulmonary sites 8 4/4 6 5/1 - - 14 9/5
* Number of localization at single sites (primary/recurrent cases) in 43 patients with extrapulmonary metastases.
49% 43%
33%
![Page 25: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/25.jpg)
Local Relapse
Distant Mets
MLPS 5 – 9636
8 – 7215
RCLPS 8 – 6612
6 – 5420
PLPS 4 – 3012
6 – 4818
Time to Event (mos)
![Page 26: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/26.jpg)
Local Relapse
Point Estimate 95% CI
MLPS >266 143 - >266
RCLPS 103 46 - >158
PLPS >97 90 - >277
Post-Event Median Survival (mos)
![Page 27: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/27.jpg)
Lung Mets Extra-Lung Mets
Point Estimate 95% CI Point
Estimate 95% CI
MLPS 23 7 - 39 14 4 - >52
RCLPS >12 . - . >19 5 - >19
PLPS 13 6 - 98 >42 >42 - >42
Post-Event Median Survival (mos)
![Page 28: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/28.jpg)
![Page 29: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/29.jpg)
![Page 30: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/30.jpg)
![Page 31: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/31.jpg)
![Page 32: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/32.jpg)
![Page 33: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/33.jpg)
![Page 34: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/34.jpg)
•the surgeon
![Page 35: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/35.jpg)
Intralesional 100%
Marginal 60-80%
Wide 10-30%
Radical < 5%
LR
Enzinger and Weiss’s SOFT TISSUE TUMORS - 2001
![Page 36: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/36.jpg)
Margins status: +/- 2.161** 1.2333.78
7 0.0071
Hazard Ratio 95% C. I. P
Multivariate Analysis - DSS
![Page 37: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/37.jpg)
Local recurrence has an independent effect on
prognosis
![Page 38: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/38.jpg)
Recurrent: Disease-Specific Survival
Years
0 1 2 3 4 5 6 7 8 9 10
Pro
babi
lity
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
MLPSRCLPSPLPS
0.1512P
115 Recurrent Myxoid/RC LPS - DSS INT 1980-2005
5-yrs 10-yrs
Overall 72% 56%
MLPS 79% 62%
RCLPS 58% 43%
PLPS 64% 53%
![Page 39: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/39.jpg)
Recurrent: Crude Cumulative Incidence of Local-Regional Relapse
Years
0 1 2 3 4 5 6 7 8 9 10
Pro
babi
lity
0.0
0.1
0.2
0.3
0.4
0.5
0.6
MLPSRCLPSPLPS
0.2837P
115 Recurrent Myxoid/RC LPS - LR INT 1980-2005
5-yrs 10-yrs
Overall 37% 39%
MLPS 35% 37%
RCLPS 31% 31%
PLPS 48% 52%
![Page 40: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/40.jpg)
Recurrent: Crude Cumulative Incidence of Distant Metastasis
Years
0 1 2 3 4 5 6 7 8 9 10
Pro
ba
bilit
y
0.0
0.1
0.2
0.3
0.4
0.5
0.6MLPSRCLPSPLPS
0.0164P
115 Recurrent Myxoid/RC LPS - DM INT 1980-2005
5-yrs 10-yrs
Overall 22% 23%
MLPS 19% 19%
RCLPS 44% 44%
PLPS 13% 17%
![Page 41: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/41.jpg)
… in conclusion
![Page 42: CTOS 12th Annual Meeting Venice, 2-4 November 2006](https://reader035.fdocuments.in/reader035/viewer/2022070410/56814664550346895db385c9/html5/thumbnails/42.jpg)
Prognosis of myxoid/round cell liposarcoma is relatively good, if compared with other STS
Cut-off of 5% of RC component single out a group tumor with 81% 10-yrs DSS, which is actually in the range of intermediate grade STS
As expected, phase at presentation, tumor size and grade, and surgical margins are independent prognostic factors for survival
Pattern of metastases can affect survival