Surgically treated pelvic liposarcoma and leiomyosarcoma: The effect of tumor size on cancer-specific survival

Andrea Baudo; Mattia Luca Piccinelli; Reha-Baris Incesu; Simone Morra; Lukas Scheipner; Francesco Barletta; Stefano Tappero; Cristina Cano Garcia; Anis Assad; Zhe Tian; Pietro Acquati; Ottavio de Cobelli; Nicola Longo; Alberto Briganti; Carlo Terrone; Felix K H Chun; Derya Tilki; Sascha Ahyai; Fred Saad; Shahrokh F Shariat; Luca Carmignani; Pierre I Karakiewicz

doi:10.1016/j.suronc.2024.102074

Surgically treated pelvic liposarcoma and leiomyosarcoma: The effect of tumor size on cancer-specific survival

Surg Oncol. 2024 Apr 9:54:102074. doi: 10.1016/j.suronc.2024.102074. Online ahead of print.

Authors

Andrea Baudo¹, Mattia Luca Piccinelli², Reha-Baris Incesu³, Simone Morra⁴, Lukas Scheipner⁵, Francesco Barletta⁶, Stefano Tappero⁷, Cristina Cano Garcia⁸, Anis Assad⁹, Zhe Tian⁹, Pietro Acquati¹⁰, Ottavio de Cobelli¹¹, Nicola Longo¹², Alberto Briganti⁶, Carlo Terrone⁷, Felix K H Chun⁸, Derya Tilki¹³, Sascha Ahyai¹⁴, Fred Saad⁹, Shahrokh F Shariat¹⁵, Luca Carmignani¹⁶, Pierre I Karakiewicz⁹

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy. Electronic address: andrea.baudo@outlook.it.
² Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.
⁵ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria.
⁶ Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁷ Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
⁸ Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.
⁹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
¹⁰ Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
¹¹ Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
¹² Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.
¹³ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey.
¹⁴ Department of Urology, Medical University of Graz, Graz, Austria.
¹⁵ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹⁶ Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.

PMID: 38615387
DOI: 10.1016/j.suronc.2024.102074

Abstract

Introduction: In soft tissue pelvic liposarcoma and leiomyosarcoma, it is unknown whether a specific tumor size cut-off may help to better predict prognosis, defined as cancer-specific survival (CSS). We tested whether different tumor size cut-offs, could improve CSS prediction.

Materials and methods: Surgically treated non-metastatic soft tissue pelvic sarcoma patients were identified (Surveillance, Epidemiology, and End Results 2004-2019). Kaplan-Meier plots, univariable and multivariable Cox-regression models and receiver operating characteristic-derived area under the curve (AUC) estimates were used.

Results: Overall, 672 (65 %) liposarcoma (median tumor size 11 cm, interquartile range [IQR] 7-16) and 367 (35 %) leiomyosarcoma (median tumor size 8 cm, IQR 5-12) patients were identified. The p-value derived ideal tumor size cut-off was 17.1 cm, in liposarcoma and 7.0 cm, in leiomyosarcoma. In liposarcoma, according to p-value derived cut-off, five-year CSS rates were 92 vs 83 % (≤17.1 vs > 17.1 cm). This cut-off represented an independent predictor of CSS and improved prognostic ability from 83.8 to 86.8 % (Δ = 3 %). Similarly, among previously established cut-offs (5 vs 10 vs 15 cm), also 15 cm represented an independent predictor of CSS and improved prognostic ability from 83.8 to 87.0 % (Δ = 3.2 %). In leiomyosarcoma, according to p-value derived cut-off, five-year CSS rates were 86 vs 55 % (≤7.0 vs > 7.0 cm). This cut-off represented an independent predictor of CSS and improved prognostic ability from 68.6 to 76.5 % (Δ = 7.9 %).

Conclusions: In liposarcoma, the p-value derived tumor size cut-off was 17.1 cm vs 7.0 cm, in leiomyosarcoma. In both histologic subtypes, these cut-offs exhibited the optimal statistical characteristics (univariable, multivariable and AUC analyses). In liposarcoma, the 15 cm cut-off represented a valuable alternative.

Keywords: Cancer-specific survival; Leiomyosarcoma; Liposarcoma; Pelvic soft tissue sarcoma; Tumor size cut-off.