Prognostic factors for long term survival in patients with metastatic sarcoma; the view from a single centre

Abstract

9022 Background: Median survival after diagnosis of metastases in sarcoma is < 1yr, but ∼10% survive >5 years. Previous studies have used specific patient cohorts that may not be reflective of a general sarcoma practice, thus this study was performed to determine factors predictive of long term survival in unselected metastatic sarcoma patients seen at a large sarcoma unit, with a subset analysis of adult soft tissue sarcoma patients. Methods: A retrospective review of the Royal Marsden Hospital Sarcoma database of all sarcoma patients (pts) who developed metastatic disease before 30 November 1999 was undertaken and variables including age, histology, size and grade of primary, stage at diagnosis, time to 1st metastatic relapse, sites and number of metastases, and treatment were compared. Pts lost to follow up were excluded. A subgroup analysis of adults (≥16yrs) with soft tissue sarcoma was also performed. Results 919 pts who developed metastatic sarcoma before 30 November 1999 were reviewed. Multivariate analysis showed that independent variables for poorer survival were higher grade (p<0.005), older age P<0.001), shorter time to 1st relapse (p<0.001) and presence of extrapulmonary metastases (p<0.001). 611 adults had metastatic soft tissue sarcoma, 106 (17.3%) survived ≥ 5yrs. Median survival after development of metastases was 14 mos (range; 1–400 mos), for those that survived ≥ 5yrs the median survival was 91.5 mos. Significant variables predictive of long term survival include time to relapse, initial stage, grade, and histological subtype; leiomyosarcoma, synovial sarcoma, MFH, angiosarcoma, and GIST being especially poor. Conclusions: This study aimed to determine prognostic survival variables for metastatic sarcoma irrespective of therapy. Age, as well as variables reflecting tumour biology such as grade, and time to 1st relapse were found to be important. For adult soft tissue sarcoma patients, histological subtype was also significant. Survival with metastatic sarcoma would appear to be dependent on the biology of the primary and preliminary analysis also indicated that response to chemotherapy and metastatectomy also played a key role. No significant financial relationships to disclose.