title: Prognostic factors and impact of adjuvant treatments on local and metastatic relapse of soft-tissue sarcoma patients in the competing risks setting.
abstract: BACKGROUND
  In the medical literature many analyses of outcomes of sarcoma patients were performed without regard to the problem of "competing risks."
  
  
  METHODS
  We analyzed local relapse-free and metastasis-free survival in a population of 3255 adult patients with a primary soft-tissue sarcoma (STS) included in the French Sarcoma Group database. Cumulative incidence of local and metastatic relapse was estimated by accounting for death as a competing event.
  
  
  RESULTS
  On multivariate analysis, age, tumor site, histological subtype, and grade were independent adverse prognostic factors for local relapse, whereas tumor depth and size had no influence. Histological subtype, tumor depth, tumor size, and grade were independent adverse prognostic factors for metastatic relapse. Despite a higher incidence of competing deaths in patients managed with adjuvant radiotherapy than in patients not receiving radiotherapy, adjuvant radiotherapy was associated with a significant benefit in terms of local relapse-free survival. Despite a similar cumulative incidence of competing deaths in patients with grade 2 and grade 3 disease, we found that the benefit of adjuvant chemotherapy was present only in patients with grade 3 and not in patients with grade 2 disease.
  
  
  CONCLUSIONS
  In the setting of competing risks, tumor biology reflected by histological grade is a crucial predictor of local relapse, whereas tumor depth and size have poor if any influence. Grade could also predict the benefit of adjuvant chemotherapy in patients with STS.
authors.affiliation: Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Italiano
authors.forename: Axel
authors.initials: A
authors.lastname: Le Cesne
authors.forename: Jean
authors.initials: J
authors.lastname: Mendiboure
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: Sophie
authors.initials: S
authors.lastname: Piperno-Neumann
authors.forename: Christine
authors.initials: C
authors.lastname: Chevreau
authors.forename: Corinne
authors.initials: C
authors.lastname: Delcambre
authors.forename: Nicolas
authors.initials: N
authors.lastname: Penel
authors.forename: Philippe
authors.initials: P
authors.lastname: Terrier
authors.forename: Dominique
authors.initials: D
authors.lastname: Ranchere-Vince
authors.forename: Marick
authors.initials: M
authors.lastname: Lae
authors.forename: Sophie
authors.initials: S
authors.lastname: Le Guellec
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Michels
authors.forename: Yves Marie
authors.initials: YM
authors.lastname: Robin
authors.forename: Carine
authors.initials: C
authors.lastname: Bellera
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonvalot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D012307:Risk Factors; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome
keywords: competing risks; prognosis; soft-tissue sarcoma; treatment