Effect of adjuvant chemotherapy on survival in FNCLCC grade 3 soft tissue sarcomas: a multivariate analysis of the French Sarcoma Group Database.
BACKGROUND
The predictive value of grade for benefit from adjuvant chemotherapy (AC) in soft tissue sarcoma (STS) patients has never been explored.


METHODS
From 1980 to 1999, 1513 adult patients with non-metastatic STS were included prospectively in the French Sarcoma Group database. Grade was assessed according to the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) system after central review.


RESULTS
AC was delivered to 13 grade 1 patients (3%), 145 grade 2 patients (35%) and 262 grade 3 patients (62%). Young age, non-well-differentiated liposarcoma histology, deep location, bone and/or neurovascular invasion and grade 2 or 3 were significantly associated with a higher likelihood to receive AC. Median follow-up was 9 years. On multivariate analysis, AC was significantly associated with improved metastasis-free survival (MFS) [5-year MFS: 58% versus 49%, hazard ratio (HR) 0.7 (95% confidence interval (CI) 0.6-0.9), P = 0.01] and overall survival (OS) [5-year OS: 58% versus 45%, HR 0.6 (95% CI 0.5-0.8), P = 0.0002] in grade 3 patients. This was not observed in grade 2 patients [5-year MFS: 76% versus 73%, HR 0.8 (95% CI 0.5-1.2), P = 0.27; 5-year OS: 75% versus 65%, HR 0.8 (95% CI 0.6-1.1), P = 0.15].


CONCLUSIONS
This large cohort-based analysis with long-term follow-up indicates that patients with FNCLCC grade 3 disease may benefit from AC.
Italiano
A
A
Department of Medical Oncology, Institut Bergonié, Bordeaux. Electronic address: italiano@bergonie.org.
Delva
F
F
INSERM CIC-EC7, Université Victor Ségalen, Bordeaux; Clinical Research Unit, Institut Bergonié, Bordeaux.
Mathoulin-Pelissier
S
S
INSERM CIC-EC7, Université Victor Ségalen, Bordeaux; Clinical Research Unit, Institut Bergonié, Bordeaux.
Le Cesne
A
A
Department of Medecine.
Bonvalot
S
S
Department of Surgery.
Terrier
P
P
Department of Pathology, Institut Gustave Roussy, Villejuif.
Trassard
M
M
Department of Pathology, Centre René Huguenin, Saint-Cloud.
Michels
J-J
JJ
Department of Pathology, Centre François Baclesse, Caen.
Blay
J-Y
JY
Department of Medicine, Centre Léon Bérard, Lyon.
Coindre
J-M
JM
Department of Pathology, Institut Bergonie, Bordeaux, France.
Bui
B
B
Department of Medical Oncology, Institut Bergonié, Bordeaux.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012107:Research Design; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis; D055815:Young Adult