Sequential multimodal treatments with chemotherapy and surgery for advanced soft tissue sarcoma may be associated with better survival than chemotherapy

Ching-Tso Chen; Hsing-Wu Chen; Wei-Hsin Lin; Pei-Ming Huang; Mong-Wei Lin; Ching-Yao Yang; Che-Yu Hsu; Chia-Chun Wang; Jen-Chieh Lee; Koping Chang; Kuo-Hao Huang; Ho-Min Chen; Tom Wei-Wu Chen; Rong-Sen Yang; Ruey-Long Hong

doi:10.1016/j.jfma.2024.03.007

Sequential multimodal treatments with chemotherapy and surgery for advanced soft tissue sarcoma may be associated with better survival than chemotherapy

J Formos Med Assoc. 2024 Mar 23:S0929-6646(24)00152-9. doi: 10.1016/j.jfma.2024.03.007. Online ahead of print.

Authors

Ching-Tso Chen¹, Hsing-Wu Chen², Wei-Hsin Lin³, Pei-Ming Huang⁴, Mong-Wei Lin⁵, Ching-Yao Yang⁶, Che-Yu Hsu⁷, Chia-Chun Wang⁸, Jen-Chieh Lee⁹, Koping Chang¹⁰, Kuo-Hao Huang¹¹, Ho-Min Chen¹², Tom Wei-Wu Chen¹³, Rong-Sen Yang¹⁴, Ruey-Long Hong¹⁵

Affiliations

¹ Department of Oncology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan, R.O.C; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C. Electronic address: robarroyce@gmail.com.
² Department of Oncology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan, R.O.C; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C. Electronic address: hsingwuc@gmail.com.
³ Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Electronic address: ethanlin@ntuh.gov.tw.
⁴ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Electronic address: phuang3@ntuh.gov.tw.
⁵ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Electronic address: mwlin@ntu.edu.tw.
⁶ Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C. Electronic address: cyang@ntuh.gov.tw.
⁷ Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C; Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, R.O.C. Electronic address: codiwa@ntuh.gov.tw.
⁸ Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C; Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, R.O.C. Electronic address: chiachun@ntuh.gov.tw.
⁹ Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Electronic address: leejenchieh@ntuh.gov.tw.
¹⁰ Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Electronic address: koping@ntuh.gov.tw.
¹¹ Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Electronic address: khhuang@ntuh.gov.tw.
¹² Health Data Research Center, National Taiwan University, Taipei, Taiwan, R.O.C. Electronic address: homin.chen@gmail.com.
¹³ Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, R.O.C; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C. Electronic address: tomwchen@ntuh.gov.tw.
¹⁴ Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Electronic address: rsyang@ntuh.gov.tw.
¹⁵ Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, R.O.C. Electronic address: rlhong@ntuh.gov.tw.

PMID: 38521760
DOI: 10.1016/j.jfma.2024.03.007

Abstract

Background: In patients with advanced soft tissue sarcoma (STS), surgery had been reported to be associated with superior overall survival (OS). Chemotherapy details for such patients were less reported, and whether multimodal treatment with surgery and chemotherapy provides extra survival benefit remains unclear.

Methods: We retrospectively reviewed patients with newly diagnosed advanced STS treated at National Taiwan University Hospital from January 1, 2011, to December 31, 2017. OS was calculated from the day of diagnosis of advanced STS to the day of death or last follow-up. Baseline patient characteristics and details regarding surgery and chemotherapy were recorded.

Results: A total of 545 patients were diagnosed with STS from 2011 to 2017, of which 226 patients had advanced STS. The median age was 54.7 years, and 54% of patients were women. Approximately 38% of patients with advanced STS underwent surgery and exhibited a trend of longer OS compared with who did not (median = 18.6 vs. 11.9 months, p = 0.083). In the chemotherapy subgroup, the benefit of surgery was more prominent (median = 21.9 vs. 16.5 months, p = 0.037). Patients who received chemotherapy prior to surgery exhibited numerically longer OS than those who underwent surgery first (median = 33.9 vs. 18.3 months, p = 0.155). After adjusting other clinical factors, chemotherapy remained an independent factor associated with favourable OS.

Conclusion: Surgery may be more beneficial for the patients who receive chemotherapy. Our results support evaluation of sequential multimodal treatments strategy including surgery and chemotherapy in patients with advanced STS.

Keywords: Advanced soft tissue sarcoma; Chemotherapy; Metastasectomy; Multimodal treatments; Surgery.