Real-world evidence on perioperative chemotherapy in localized soft tissue sarcoma of the extremities and trunk wall; a population-based study

Figures & data

Figure 1. Flowchart of the study cohort.

Table 1. Demographic, clinical and histopathological characteristics of patients who received perioperative chemotherapy.

	Number of patients (%)
Age, median (range)	53 (18–73)
Sex
Female	69 (45)
Male	85 (55)
Year of diagnosis
1998–2007	67 (44)
2008–2017	87 (56)
Primary tumor location
Lower extremity	97 (63)
Upper extremity	19 (12)
Trunk	38 (25)
Histological subtype
UPS	42 (27)
Myxofibrosarcoma	31 (20)
Leiomyosarcoma	12 (8)
Myxoid liposarcoma	6 (4)
Liposarcoma, other	16 (10)
Synovial sarcoma	20 (13)
MPNST	12 (8)
Not classified	8 (5)
Other	7 (5)*
Tumor size (cm), median (range)	10.0 (1.1–27.0)
Mitotic count per 10 HPF, median (range)	15 (1–60)
Tumor depth
Subcutaneous	13 (8)
Deep	141 (92)
FNCLCC grade
1	1 (1)^#
2	41 (27)
3	74 (48)
ND	38 (25)
Surgical margin
R0	141 (92)
R1	13 (8)
Radiotherapy
Yes	110 (71)
No	44 (29)
Tumor necrosis
Absent	13 (8)
Present	133 (86)
<50%	88 (57)
≥50%	26 (17)
Percentage ND	19 (12)
ND	8 (5)
Vascular invasion
Absent	119 (77)
Present	23 (15)
ND	12 (8)
Tumor growth pattern
Pushing	6 (4)
Infiltrating	91 (59)
ND	57 (37)

*Other subtypes included extraskeletal osteosarcoma (4), pleomorphic rhabdomyosarcoma (2), and angiosarcoma (1).

^#Initially considered as grade 2, but reclassified to grade 1 after pathology review.

UPS, undifferentiated pleomorphic sarcoma; MPNST, malignant peripheral nerve sheath tumor; HPF, high-power field of the microscope; FNCLCC, Fédération Nationale des Centers de Lutte Contre Le Cancer; ND, not determined.

Table 2. A comparison of the demographic, clinical and histopathological characteristics of the RWD cohort and the clinical study cohort.

	RWD cohort	Clinical study cohort	P value^#
Age, median (range)	50 (19–71)	54 (18–73)	0.015
Sex			0.052
Female	38 (54)	31 (37)
Male	33 (46)	52 (63)
Year of diagnosis			0.625
1998–2007	29 (41)	38 (46)
2008–2017	42 (59)	45 (54)
Primary tumor location			0.401
Lower extremity	41 (58)	56 (67)
Upper extremity	9 (13)	10 (12)
Trunk	21 (30)	17 (21)
Histological subtype			0.002
UPS	19 (27)	23 (28)
Myxofibrosarcoma	7 (10)	24 (29)
Leiomyosarcoma	5 (7)	7 (8)
Myxoid liposarcoma	1 (1)	5 (6)
Liposarcoma, other	7 (10)	9 (11)
Synovial sarcoma	14 (20)	6 (7)
MPNST	6 (8)	6 (7)
Not classified	5 (7)	3 (4)
Other	7 (10)	0 (0)
Tumor size (cm), median (range)	9.3 (1.1–26.0)	11.0 (3.0–27.0)	0.053
Mitotic count per 10 HPF, median (range)	13 (1–57)	17 (1–60)	0.106
Tumor depth			0.144
Subcutaneous	3 (4)	10 (12)
Deep	68 (96)	73 (88)
FNCLCC grade			1.000
1	0 (0)	1 (1)*
2	17 (24)	24 (29)
3	32 (45)	42 (51)
ND	22 (32)	16 (19)
Surgical margin			0.262
R0	63 (89)	78 (94)
R1	8 (11)	5 (6)
Radiotherapy			1.000
Yes	51 (72)	59 (71)
No	20 (28)	24 (29)
Tumor necrosis			0.766^$
Absent	6 (8)	7 (8)
Present	59 (83)	74 (89)
<50%	36 (51)	52 (63)
≥50%	12 (17)	14 (17)
Percentage ND	17 (24)	10 (12)
ND	6 (8)	2 (2)
Vascular invasion			0.365
Absent	55 (77)	64 (77)
Present	8 (11)	15 (18)
ND	8 (11)	4 (5)
Tumor growth pattern			0.401
Pushing	4 (6)	2 (2)
Infiltrating	39 (55)	52 (63)
ND	28 (39)	29 (35)

*Initially considered as grade 2, but reclassified to grade 1 after pathology review.

^#P values are from Mann-Whitney U test, Fisher’s exact test or Pearson’s chi-squared test as appropriate. Cases with ND are not included in the statistical analyses.

^$P value based on the present versus absent.

RWD, real-world data; UPS, undifferentiated pleomorphic sarcoma; MPNST, malignant peripheral nerve sheath tumor; HPF, high-power field of the microscope; FNCLCC, Fédération Nationale des Centers de Lutte Contre Le Cancer; ND, not determined.

Figure 2. Kaplan-Meier curves of metastasis-free (A, C, D) and overall survival (B) in patients who received perioperative chemotherapy. (A, B) The total chemotherapy cohort. (C) The total chemotherapy cohort was stratified based on whether patients were included in a clinical trial. (D) Patients who received perioperative chemotherapy with doxorubicin and ifosfamide were stratified based on clinical trial inclusion. RWD; real-world data.

Data availability statement

The data that support the findings of this study are available from the corresponding author (KB) upon reasonable request.