Overall survival in patients with re-excision of positive microscopic margins of limb and trunk wall soft tissue sarcoma operated outside of a reference center: a nationwide cohort analysis
Francois Gouin,
Eberhard Stoeckle,
Charles Honoré,
Mickael Ropars,
Mehrdad Jafari,
Jean Camille Mattei,
Alexandre Rochwerger,
Sébastien Carrere,
Denis Waast,
Gwenaël Ferron,
Jean-Christophe Machiavello,
Philippe Anract,
Frédéric Marchal,
François Sirveaux,
Oren Marco,
Jérôme Guiramand,
Brice Paquette,
Antonio Di Marco,
Sylvain Causeret,
Jean-Marc Guilloit,
Pauline Soibinet,
Dimitri Tzanis,
Pierre Gimbergues,
Fabrice Fiorenza,
Franck Dujardin,
Louis R. Le Nail,
Jean-Christophe Ruzic,
Claire Chemin-Airiau,
Magali Morelle,
Pierre Meeus,
Marie Karanian,
François Le Loarer,
Gualter Vaz,
Jean-Yves Blay,
on behalf of the NETSARC/RREPS and French Sarcoma Group-Groupe d’Etude des Tumeurs Osseuses (GSF-GETO) networks
Affiliations
Francois Gouin
Surgery department, Centre Léon Bérard
Eberhard Stoeckle
Surgery department, Institut Bergonié
Charles Honoré
Surgery department, Gustave Roussy Cancer Campus
Mickael Ropars
Orthopedic surgery department, CHU de Rennes
Mehrdad Jafari
General and digestive oncologic surgery, Centre Oscar Lambret
Jean Camille Mattei
Ramsay Santé, Hôpital Privé Clairval
Alexandre Rochwerger
INSERM, MMG
Sébastien Carrere
Surgery department, Institut de recherche en cancérologie
Denis Waast
Orthopedic and traumatologic surgery clinic, CHU
Gwenaël Ferron
Surgery department, Toulouse Oncopole
Jean-Christophe Machiavello
Senology surgery department, Onco-gynécologique et Reconstructrice, Centre Antoine Lacassagne
Philippe Anract
Orthopedic surgery department, Hôpital Cochin, AP-HP
Frédéric Marchal
Surgery department, Institut de Cancérologie de Lorraine, Université de Lorraine, CNRS, CRAN, UMR 7039
François Sirveaux
Orthopedy department, CHU de Nancy
Oren Marco
Reconstructive et esthetic plastic surgery, Hôpital Saint Louis
Jérôme Guiramand
Surgery department, Institut Paoli Calmette
Brice Paquette
Department of Digestive Surgery, Jean Minjoz University Hospital
Antonio Di Marco
Orthopedic surgery department, CHU de Strasbourg
Sylvain Causeret
Surgery department, Centre George-François Leclerc
Jean-Marc Guilloit
Visceral et digestive surgery department, Centre François Baclesse
Pauline Soibinet
Medical Oncology department, Institut J Godinot
Dimitri Tzanis
Surgery department, Institut Curie, PSL university
Pierre Gimbergues
Surgery department, Centre Jean Perrin
Fabrice Fiorenza
Orthopedic and traumatology surgery department, CHU Limoges
Franck Dujardin
Medical Oncology and Surgical Oncology department, Centre Henri Becquerel
Louis R. Le Nail
Onco-orthopedic surgery department, Hôpital Trousseau, CHRU de Tours
Jean-Christophe Ruzic
Orthopedic surgery, CHU St-Pierre
Claire Chemin-Airiau
Clinical research and innovation department, Centre Léon Bérard
Magali Morelle
Clinical research and innovation department, Centre Léon Bérard
Pierre Meeus
Surgery department, Centre Léon Bérard
Marie Karanian
Department of Biopathology, Centre Léon Bérard
François Le Loarer
Anatomo-pathology surgery department, Institut Bergonié
Gualter Vaz
Surgery department, Centre Léon Bérard
Jean-Yves Blay
Medical oncology Centre Léon Bérard
on behalf of the NETSARC/RREPS and French Sarcoma Group-Groupe d’Etude des Tumeurs Osseuses (GSF-GETO) networks
Abstract Background This French nationwide NETSARC exhaustive prospective cohort aims to explore the impact of systematic re-excision (RE) as adjuvant care on overall survival (OS), local recurrence free survival (LRFS), and local and distant control (RFS) in patients with soft tissue sarcoma (STS) with positive microscopic margins (R1) after initial resection performed outside of a reference center. Methods Eligible patients had experienced STS surgery outside a reference center from 2010 to 2017, and had R1 margins after initial surgery. Characteristics and treatment comparisons used chi-square for categorical variables and Kruskall-Wallis test for continuous data. Survival distributions were compared in patients reexcised (RE) or not (No-RE) using a log-rank test. A Cox proportional hazard model was used for subgroup analysis. Results A total of 1,284 patients had experienced initial STS surgery outside NETSARC with R1 margins, including 1,029 patients with second operation documented. Among the latter, 698 patients experienced re-excision, and 331 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, tumor size, tumor depth, and histotype in the population of patients re-excised (RE) or not (No-RE). The study identified RE as an independent favorable factor for OS (HR 0.36, 95%CI 0.23–0.56, p<0.0001), for LRFS (HR 0.45, 95%CI 0.36–0.56, p<0.0001), and for RFS (HR 0.35, 95%CI 0.26–0.46, p<0.0001). Conclusion This large nationwide series shows that RE improved overall survival in patients with STS of extremities and trunk wall, with prior R1 resection performed outside of a reference center. RE as part of adjuvant care should be systematically considered. Level of evidence II
