Survival prognostic factors in unresectable/advanced primary thoracic sarcomas

Our plain-English summary of Survival prognostic factors in unresectable/advanced primary thoracic sarcomas, by J.R. Rodriguez-Cid, J.J. Juarez-Vignon Whaley, G. Sánchez-Domínguez, et al (Journal of Thoracic Disease, 2022).

The study

• Authors: J.R. Rodriguez-Cid, J.J. Juarez-Vignon Whaley, G. Sánchez-Domínguez, J. Guzmán-Casta, S. Carrasco-CaraChards, J.A. Alatorre-Alexander, L.M. Martínez-Barrera, C.P. Sánchez-Rios, R.R. Flores-Mariñelarena, A. Seidman-Sorsby, M. Cruz-Zermeño, I.J. Rodríguez-Zea, P.J. Santillan-Doherty
• Journal: Journal of Thoracic Disease
• Published: 2022;14(9):3376-3385
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary thoracic sarcomas (PTS) including primary pulmonary and chest wall sarcomas (CWS), are aggressive lung malignancies with limited information specially in an advanced/unresectable setting. Unfortunately, prognostic factors for these malignancies are not well identified.

Methods: Retrospective cohort analysis of patients diagnosed with unresectable/advanced soft tissue PTS from a third level reference institute. Univariate and multivariate analysis performed via Cox-regression model. Progression-free survival (PFS) and overall survival (OS) analysis via Kaplan-Meier method.

Results: A total of 157 patients were identified, 55.4% female, mean age 51.8 years (range, 18-90 years), 19.1% tobacco exposure and 10.8% asbestos exposure. The most common performance status was Eastern Cooperative Oncology Group (ECOG) 1 (38.9%), most common clinical presentation cough (58.4%) and thoracic pain (55.4%). Undifferentiated sarcoma (37.6%) followed by synovial sarcoma (34.4%) were the most common histologies. Most patients received five chemotherapeutic cycles (37.6%), 57.3% of patients obtained a partial response and 61.1% an overall response rate (ORR). Median PFS was 9 months [95% confidence interval (CI): 8.717-9.283 months]. The multivariable analysis identified ECOG ≥2, a poorer response to chemotherapy (less number of chemotherapy cycles) and an increase Response Evaluation Criteria in Solid Tumors (RECIST) to be associated with a shorter progression-free period. Median OS was 11 months (95% CI: 10.402-11.958 months) with an ECOG ≥2 and a poorer response to chemotherapy (less number of chemotherapy cycles) associated with a shorter survival.

Conclusions: Age, gender, comorbidities, tobacco and asbestos exposure, clinical presentation and histopathological diagnosis are not useful prognostic factors in unresectable/advanced PTS, however, an adequate initial ECOG, RECIST and a better response to chemotherapy should be used as prognostic factors in the management of these tumors.

2022 Journal of Thoracic Disease. All rights reserved.

In plain English

This retrospective cohort study reviewed 157 adults with advanced or unresectable primary thoracic sarcomas treated in 2016–2021 at the Instituto Nacional de Enfermedades Respiratorias, Mexico City. These comprised 50 primary pulmonary and 107 chest wall sarcomas, all treated with chemotherapy. Seventeen patients (10.8%) had asbestos exposure. Fiber types and exposure assessment were not described. Median progression-free survival was 9 months (95% CI 8.717 to 9.283); median overall survival, 11 months (95% CI 10.402 to 11.958). Asbestos exposure was not significantly associated with progression-free survival (hazard ratio 0.893, 95% CI 0.539 to 1.479) or overall survival (hazard ratio 1.030, 95% CI 0.622 to 1.707). In multivariable analysis, poorer performance status (ECOG 2 or higher) and fewer chemotherapy cycles (the authors' measure of chemotherapy response) were associated with shorter progression-free and overall survival. RECIST tumor response was significant for progression-free survival in multivariable analysis, and for overall survival only in univariable analysis. The authors concluded that good performance status and chemotherapy response are associated with better outcomes. They noted the limits of a retrospective series from one center serving a Latino population.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive, observational, retrospective cohort study with univariable and multivariable Cox regression and Kaplan-Meier survival analysis
• Who was studied: 157 adults (over 18) with confirmed advanced/unresectable primary thoracic sarcoma: 50 primary pulmonary sarcomas and 107 chest wall sarcomas. They were treated at the Instituto Nacional de Enfermedades Respiratorias, Mexico City, from 2016 to 2021. 87 were female (55.4%) and the mean age was 51.8 years (range 18–90).
• Exposure: Asbestos exposure was one of several clinical variables reviewed. It was present in 17 of 157 patients (10.8%). The article does not report fiber type, source, or how exposure was assessed. Smoking was also recorded: 30 patients (19.1%) were current or former smokers. All patients received chemotherapy.
• Main results:
  • In univariable analysis, asbestos exposure was not significantly associated with progression-free survival (HR 0.893, 95% CI 0.539–1.479, P=0.660) or with overall survival (HR 1.030, 95% CI 0.622–1.707, P=0.908).
  • Median progression-free survival for all patients was 9 months (95% CI 8.717–9.283 months).
  • Median overall survival for all patients was 11 months (95% CI 10.402–11.958).
  • In multivariable analysis of progression-free survival, three factors were significant: chemotherapy responders (HR 0.561, 95% CI 0.475–0.662, P<0.001), RECIST (HR 1.277, 95% CI 1.108–1.473, P<0.001) and ECOG 2 or higher (HR 1.523, 95% CI 1.051–2.207, P=0.026).
  • In univariable analysis of overall survival, RECIST was significantly associated with overall survival (HR 1.272, 95% CI 1.103–1.467, P<0.001).
  • In multivariable analysis of overall survival, chemotherapy responders (HR 0.689, 95% CI 0.596–0.798, P<0.001) and ECOG 2 or higher (HR 1.728, 95% CI 1.196–2.496, P=0.004) were significant. RECIST was not significant (HR 1.143, 95% CI 0.990–1.320, P=0.068).
  • 96 of 157 patients (61.1%) had an overall response (partial plus complete response) to chemotherapy.
• The authors' conclusion: The authors concluded that good performance status (ECOG under 2) and a good response to chemotherapy are associated with better progression-free and overall survival. They also concluded that, for overall survival, treatment response measured by RECIST or ORR does not offer a prognostic factor.
• Limitations the authors state:
  • The authors acknowledged the inherent limitations of a retrospective series. They said these were addressed with precise and specific inclusion criteria.
  • The study came from one national center serving a Latino population. The authors noted that the most common histologic subtypes may vary between populations.
  • Comparing efficacy between chemotherapy regimens was not an objective of this study.

Topics

Medical terms in this study, explained in our Lexicon: Unresectable, Sarcoma, Multivariate Analysis, Progression-Free Survival, Overall Survival, Asbestos Exposure, Performance Status, Synovial Sarcoma.

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