The mitotic rate as a prognostic biomarker after preoperative radiotherapy for high-grade limb/trunk soft tissue sarcoma

IF 5.3 1区医学 Q1 ONCOLOGY Radiotherapy and Oncology Pub Date : 2024-08-17 DOI:10.1016/j.radonc.2024.110482

Zhengxiao Ouyang , Tianyu Wang , Jennifer Brown , Zsolt Orosz , Sally Trent , Thomas Cosker , Harriet Branford White , Duncan Whitwell , Xiaoning Guo , Christopher Leonard Maxime Gibbons

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Abstract

Purpose

Currently there is no generally accepted standardized approach for the pathological evaluation of soft tissue sarcoma (STS) histology appearance after preoperative radiotherapy (PORT). This study aimed to investigate the prognostic value of pathological appearance after PORT for patients with high-grade limb/trunk STS.

Methods

A cohort of 116 patients with high-grade STS of the limb/trunk treated with PORT followed by resection were evaluated. Patient characteristics, imaging tumor morphology (size, volume), and histopathology (mitotic and necrosis rate, viable cell, hyalinization/fibrosis cytopathic effect) were reviewed and reassessed. Disease free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method, and the hazard ratio was derived from Cox proportional hazard models. Two predictive nomograms were calculated based on significant predictors identified.

Results

The 5-year DFS and OS were 52.9% and 70.3%, respectively. Tumor size before (HR:1.07, 95%CI: 1.01–1.14) and after PORT (HR:1.08, 95%CI: 1.01–1.14), tumor volume (HR:1.06, 95%CI: 1.01–1.12), mitotic rate after PORT (HR: 1.06, 95%CI: 1.02–1.11), mitotic rate change after PORT (HR:1.04, 95%CI:1.00–1.09) were independent risk factors for DFS. Tumor size before (HR:1.08, 95%CI: 1.03–1.14) and after PORT (HR:1.09, 95%CI: 1.04–1.15), tumor volume (HR:1.05, 95%CI: 1.01–1.09), mitotic rate after PORT (HR: 1.09, 95%CI: 1.04–1.13), mitotic rate change after PORT (HR:1.05, 95%CI:1.01–1.09) were independent risk factors for OS. The C-index of pathologic predictive nomogram based on mitotic rate for DFS and OS were 0.67 and 0.73, respectively. The C-index of morphology-pathology predictive nomogram for OS was 0.79.

Conclusion

Tumor size before and after PORT, tumor volume, mitotic rate after PORT, mitotic rate change after PORT were independent risk factors for DFS and OS in high-grade STS patients treated with PORT. The mitotic rate, independent of tumor morphology, showed its potential as a prognostic biomarker for pathologic evaluation in patients treated with PORT.

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有丝分裂率是高级别肢体/躯干软组织肉瘤术前放疗后的预后生物标志物。

目的：目前，对于术前放疗（PORT）后软组织肉瘤（STS）组织学外观的病理学评估还没有公认的标准化方法。本研究旨在探讨PORT术后病理外观对高级别肢体/躯干STS患者的预后价值：方法：对116例肢体/躯干高级别STS患者进行了评估。对患者特征、影像学肿瘤形态（大小、体积）和组织病理学（有丝分裂率和坏死率、存活细胞、透明化/纤维化细胞病理效应）进行了回顾和重新评估。采用 Kaplan-Meier 法计算无病生存期（DFS）和总生存期（OS），并通过 Cox 比例危险模型得出危险比。根据确定的重要预测因子计算了两个预测提名图：结果：5 年 DFS 和 OS 分别为 52.9% 和 70.3%。PORT前（HR：1.07，95%CI：1.01-1.14）和PORT后（HR：1.08，95%CI：1.01-1.14）肿瘤大小、肿瘤体积（HR：1.06，95%CI：1.01-1.12）、PORT后有丝分裂率（HR：1.06，95%CI：1.02-1.11）、PORT后有丝分裂率变化（HR：1.04，95%CI：1.00-1.09）是DFS的独立危险因素。PORT前（HR：1.08，95%CI：1.03-1.14）和PORT后（HR：1.09，95%CI：1.04-1.15）肿瘤大小、肿瘤体积（HR：1.05，95%CI：1.01-1.09）、PORT后有丝分裂率（HR：1.09，95%CI：1.04-1.13）、PORT后有丝分裂率变化（HR：1.05，95%CI：1.01-1.09）是OS的独立危险因素。基于有丝分裂率的病理预测提名图对 DFS 和 OS 的 C 指数分别为 0.67 和 0.73。形态学-病理学预测OS提名图的C指数为0.79：结论：PORT前后肿瘤大小、肿瘤体积、PORT后有丝分裂率、PORT后有丝分裂率变化是PORT治疗高级别STS患者DFS和OS的独立危险因素。有丝分裂率与肿瘤形态无关，显示了其作为病理评估预后生物标志物的潜力。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.