Predictors of survival after resection of retroperitoneal sarcoma

A population-based analysis and critical appraisal of the AJCC Staging system

Hari Nathan, Chandrajit P. Raut, Katherine Thornton, Joseph M. Herman, Nita Ahuja, Richard D. Schulick, Michael A. Choti, Timothy M. Pawlik

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

OBJECTIVE: To identify predictors of survival after resection of retroperitoneal sarcoma (RPS) and to evaluate the performance of the American Joint Committee on Cancer (AJCC) staging system for RPS. SUMMARY BACKGROUND DATA:: Previous studies of survival after RPS resection are restricted to at most several institutions, yet the current AJCC staging system for RPS is based entirely on these relatively small studies. METHODS:: Patients undergoing resection of primary RPS from 1988 to 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazards models were used to analyze survival and evaluate AJCC staging. RESULTS:: In 1365 patient undergoing resection of primary RPS, the most prevalent histologies were liposarcoma (50%), leiomyosarcoma (26%), and malignant fibrous histiocytoma (11%). Median, 5-year, and 10-year survival after resection were 55 months, 47%, and 27%. Histological subtype (P < 0.001), histological grade (grade 3-4 vs. grade 1; HR, 2.42; P < 0.001), and tumor invasion of adjacent structures (HR, 1.37; P < 0.001) were associated with survival on multivariable analysis. However, tumor size had no prognostic value. Consequently, the AJCC T classification system demonstrated poor discriminatory ability (c = 0.50). The AJCC stage grouping system demonstrated moderate discriminatory ability (c = 0.66) but performed no better than a much simpler system that omits information on tumor size and lymph node metastasis (c = 0.67). CONCLUSIONS:: Indicators of tumor aggressiveness (histological grade and invasion of adjacent structures) as well as histological subtype predict survival after RPS resection. Tumor size, however, does not impact survival. The AJCC staging system for RPS is in need of revision.

Original languageEnglish (US)
Pages (from-to)970-976
Number of pages7
JournalAnnals of Surgery
Volume250
Issue number6
DOIs
StatePublished - Dec 2009

Fingerprint

Neoplasm Staging
Sarcoma
Survival
Population
Neoplasms
Malignant Fibrous Histiocytoma
Liposarcoma
Leiomyosarcoma
Survival Analysis
Proportional Hazards Models
Information Systems
Histology
Epidemiology
Lymph Nodes
Databases
Neoplasm Metastasis

Keywords

  • Retroperitoneal sarcoma
  • SEER
  • Soft tissue sarcoma
  • Staging
  • Surgery
  • Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Predictors of survival after resection of retroperitoneal sarcoma : A population-based analysis and critical appraisal of the AJCC Staging system. / Nathan, Hari; Raut, Chandrajit P.; Thornton, Katherine; Herman, Joseph M.; Ahuja, Nita; Schulick, Richard D.; Choti, Michael A.; Pawlik, Timothy M.

In: Annals of Surgery, Vol. 250, No. 6, 12.2009, p. 970-976.

Research output: Contribution to journalArticle

Nathan, Hari ; Raut, Chandrajit P. ; Thornton, Katherine ; Herman, Joseph M. ; Ahuja, Nita ; Schulick, Richard D. ; Choti, Michael A. ; Pawlik, Timothy M. / Predictors of survival after resection of retroperitoneal sarcoma : A population-based analysis and critical appraisal of the AJCC Staging system. In: Annals of Surgery. 2009 ; Vol. 250, No. 6. pp. 970-976.
@article{62b11bab00b4410185c8873b594882c4,
title = "Predictors of survival after resection of retroperitoneal sarcoma: A population-based analysis and critical appraisal of the AJCC Staging system",
abstract = "OBJECTIVE: To identify predictors of survival after resection of retroperitoneal sarcoma (RPS) and to evaluate the performance of the American Joint Committee on Cancer (AJCC) staging system for RPS. SUMMARY BACKGROUND DATA:: Previous studies of survival after RPS resection are restricted to at most several institutions, yet the current AJCC staging system for RPS is based entirely on these relatively small studies. METHODS:: Patients undergoing resection of primary RPS from 1988 to 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazards models were used to analyze survival and evaluate AJCC staging. RESULTS:: In 1365 patient undergoing resection of primary RPS, the most prevalent histologies were liposarcoma (50{\%}), leiomyosarcoma (26{\%}), and malignant fibrous histiocytoma (11{\%}). Median, 5-year, and 10-year survival after resection were 55 months, 47{\%}, and 27{\%}. Histological subtype (P < 0.001), histological grade (grade 3-4 vs. grade 1; HR, 2.42; P < 0.001), and tumor invasion of adjacent structures (HR, 1.37; P < 0.001) were associated with survival on multivariable analysis. However, tumor size had no prognostic value. Consequently, the AJCC T classification system demonstrated poor discriminatory ability (c = 0.50). The AJCC stage grouping system demonstrated moderate discriminatory ability (c = 0.66) but performed no better than a much simpler system that omits information on tumor size and lymph node metastasis (c = 0.67). CONCLUSIONS:: Indicators of tumor aggressiveness (histological grade and invasion of adjacent structures) as well as histological subtype predict survival after RPS resection. Tumor size, however, does not impact survival. The AJCC staging system for RPS is in need of revision.",
keywords = "Retroperitoneal sarcoma, SEER, Soft tissue sarcoma, Staging, Surgery, Survival",
author = "Hari Nathan and Raut, {Chandrajit P.} and Katherine Thornton and Herman, {Joseph M.} and Nita Ahuja and Schulick, {Richard D.} and Choti, {Michael A.} and Pawlik, {Timothy M.}",
year = "2009",
month = "12",
doi = "10.1097/SLA.0b013e3181b25183",
language = "English (US)",
volume = "250",
pages = "970--976",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Predictors of survival after resection of retroperitoneal sarcoma

T2 - A population-based analysis and critical appraisal of the AJCC Staging system

AU - Nathan, Hari

AU - Raut, Chandrajit P.

AU - Thornton, Katherine

AU - Herman, Joseph M.

AU - Ahuja, Nita

AU - Schulick, Richard D.

AU - Choti, Michael A.

AU - Pawlik, Timothy M.

PY - 2009/12

Y1 - 2009/12

N2 - OBJECTIVE: To identify predictors of survival after resection of retroperitoneal sarcoma (RPS) and to evaluate the performance of the American Joint Committee on Cancer (AJCC) staging system for RPS. SUMMARY BACKGROUND DATA:: Previous studies of survival after RPS resection are restricted to at most several institutions, yet the current AJCC staging system for RPS is based entirely on these relatively small studies. METHODS:: Patients undergoing resection of primary RPS from 1988 to 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazards models were used to analyze survival and evaluate AJCC staging. RESULTS:: In 1365 patient undergoing resection of primary RPS, the most prevalent histologies were liposarcoma (50%), leiomyosarcoma (26%), and malignant fibrous histiocytoma (11%). Median, 5-year, and 10-year survival after resection were 55 months, 47%, and 27%. Histological subtype (P < 0.001), histological grade (grade 3-4 vs. grade 1; HR, 2.42; P < 0.001), and tumor invasion of adjacent structures (HR, 1.37; P < 0.001) were associated with survival on multivariable analysis. However, tumor size had no prognostic value. Consequently, the AJCC T classification system demonstrated poor discriminatory ability (c = 0.50). The AJCC stage grouping system demonstrated moderate discriminatory ability (c = 0.66) but performed no better than a much simpler system that omits information on tumor size and lymph node metastasis (c = 0.67). CONCLUSIONS:: Indicators of tumor aggressiveness (histological grade and invasion of adjacent structures) as well as histological subtype predict survival after RPS resection. Tumor size, however, does not impact survival. The AJCC staging system for RPS is in need of revision.

AB - OBJECTIVE: To identify predictors of survival after resection of retroperitoneal sarcoma (RPS) and to evaluate the performance of the American Joint Committee on Cancer (AJCC) staging system for RPS. SUMMARY BACKGROUND DATA:: Previous studies of survival after RPS resection are restricted to at most several institutions, yet the current AJCC staging system for RPS is based entirely on these relatively small studies. METHODS:: Patients undergoing resection of primary RPS from 1988 to 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazards models were used to analyze survival and evaluate AJCC staging. RESULTS:: In 1365 patient undergoing resection of primary RPS, the most prevalent histologies were liposarcoma (50%), leiomyosarcoma (26%), and malignant fibrous histiocytoma (11%). Median, 5-year, and 10-year survival after resection were 55 months, 47%, and 27%. Histological subtype (P < 0.001), histological grade (grade 3-4 vs. grade 1; HR, 2.42; P < 0.001), and tumor invasion of adjacent structures (HR, 1.37; P < 0.001) were associated with survival on multivariable analysis. However, tumor size had no prognostic value. Consequently, the AJCC T classification system demonstrated poor discriminatory ability (c = 0.50). The AJCC stage grouping system demonstrated moderate discriminatory ability (c = 0.66) but performed no better than a much simpler system that omits information on tumor size and lymph node metastasis (c = 0.67). CONCLUSIONS:: Indicators of tumor aggressiveness (histological grade and invasion of adjacent structures) as well as histological subtype predict survival after RPS resection. Tumor size, however, does not impact survival. The AJCC staging system for RPS is in need of revision.

KW - Retroperitoneal sarcoma

KW - SEER

KW - Soft tissue sarcoma

KW - Staging

KW - Surgery

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=73449143153&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73449143153&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e3181b25183

DO - 10.1097/SLA.0b013e3181b25183

M3 - Article

VL - 250

SP - 970

EP - 976

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 6

ER -