Lessons Learned from the Management of 10,000 Patients with Soft Tissue Sarcoma
Murray F Brennan, Cristina Antonescu*, Nicole Moraco*, Sam Singer
Memorial Sloan-Kettering Cancer Center, New York, NY
Soft tissue sarcomas are uncommon, heterogeneous, malignancies that can occur throughout the body. Because of their rarity, their natural history has been difficult to characterize accurately.
Beginning July of 1982, we prospectively collected data on all in-patients receiving surgery for soft tissue sarcoma at our institution. By June of 2013 we had 10,000 cases. Data were reviewed weekly or bi-weekly.
Analysis of this dataset provides demographics, natural history, treatment factors and outcomes. Clinical-pathologic factors include site, size, histopathology and grade, all of which are associated with outcome. Outcomes can be predicted by nomograms that are site-, recurrence- and histology-specific. Natural history evaluation defines site-specific local recurrence and disease-specific survival (Figure 1, 2) over 30 years. Deaths from disease continue to occur >5 years from diagnosis. Among those alive at 5 years 25% of extremity, 49% of visceral, and 59% of retroperitoneal patients eventually die from disease. This demonstrates the importance of long-term follow-up for rare malignancies.
Well maintained prospective databases developed and followed for decades are a rich source for knowledge-based, histology-specific cancer care in patients with rare tumors. Mathematic models for individual patient outcome prediction require such large long-term data sets.
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