Unfavorable Prognosis in Sarcoma May Be Linked to Tumor Involvement of Fascia
Patients with fascia-infiltrating sarcoma appeared to have worse survival that those who had either strict superficial or deep soft tissue sarcomas.
|The following article features coverage from the Connective Tissue Oncology Society (CTOS) 2018 meeting. Click here to read more of Cancer Therapy Advisor's conference coverage.|
The likelihood of a poor outcome and a significantly higher recurrence risk in patients with sarcoma appeared to be associated with tumors that permeate the fascia, according to study results presented in a poster at the Connective Tissue Oncology Society (CTOS) 2018 Annual Meeting in Rome, Italy.
Although tumor depth had historically been used as a prognostic variable in cancer staging classifications of soft tissue sarcoma (STS), the 8th edition of the American Joint Committee on Cancer (AJCC) staging system removed this measure from its staging scheme in 2018, as its utility had been in question. Despite its removal from formal guidelines, tumor depth remains key for prognosis and treatment decisions in clinical practice, according to researchers from Institut Bergonié in France.
The researchers found that another variable altogether may be a better measure of prognosis: whether the tumor had infiltrated a patient's fascia. They reasoned that because tumor depth is often determined in regard to fascia, involvement of the fascia in the tumor could predict an unfavorable outcome in STS.
The French team examined 728 patients who had undergone operations for limb and trunk wall STS and categorized the patients' tumors as superficial STS underlying the fascia (sSTS), deep STS below the fascia (dSTS), or fascia-infiltrating STS (FIS). End points were surgical morbidity and functional outcome, local recurrence and metastases at 5 years, and overall survival at 5 years.
They determined that across the 3 types of sarcoma, FIS was linked to the poorest outcomes. Patients with FIS were more likely to experience major wound complications, sequels, local recurrence, metastasis, and worse survival compared with the other 2 types of sarcoma studied.
FIS-based tumors had global risk similar to that of dSTS, but were found to recur significantly more frequently than sSTS or dSTS (P = .01). This worse prognosis was likely a result of higher tumor dedifferentiation and grade 3 or higher status in FIS.
The authors concluded that even though FIS may not be an independent predictive factor, it should be considered in future risk classifications, as it “constitutes an unavoidable fact at presentation.”
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- Stoeckle E, Michot A, Crombé A, et al. Fascia-infiltrating sarcoma: a category of high risk of recurrence and poor outcome. Poster presented at: CTOS 2018 Annual Meeting; Rome, Italy: November 14-17. Poster 408.