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Gewählte Publikation:

Smolle, M.
Follow-up and outcome of patients with soft tissue sarcoma.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medical University Graz; 2021. pp. 80 [OPEN ACCESS]


Autor*innen der Med Uni Graz:
Gerger Armin
Leithner Andreas
Szkandera Joanna

Soft tissue sarcomas constitute a rare tumour entity, with an estimated incidence of 4 to 6 cases per 100.000 patients per year. The primary treatment goal in localised STS consists of surgical resections with tumour-free margins. In case of metastatic disease, developing in 20-30% of patients with initially localised disease, however, treatment options are limited, owing to the moderate response to systemic anti-tumour agents currently available. In the current cumulative thesis, four articles published since 2017 about diagnosis, treatment, or follow-up of patients with STS will be summarised and presented. The first article constitutes a review about the clinical presentation, diagnosis, therapeutic management, and outcome of STS-patients. Due to unspecific clinical signs (swelling, pain, lump increasing in size over time), imaging with ultrasound and – preferably – magnetic resonance imaging with contrast agent is required to initiate further treatment. A biopsy adhering to specific onco-surgical rules confirming the suspected diagnosis is followed by wide surgical resection. Optionally, (neo)adjuvant radiotherapy and chemotherapy may be administered. The incidence, treatment and prognosis of STS-patients with abdominal metastases (AM) is discussed in the second article. Of 769 patients with STS included in a multi-centre study, 202 developed secondary metastases (26.3%), of whom 24 presented with abdominal metastases (3.1%). Patients with liposarcoma had a significantly higher AM-risk, already highlighting differences in biological behaviour of the over 50 STS subtypes. Post-metastasis survival of patients with AM was poor, although patients undergoing metastasectomy had a better prognosis than those treated with radiotherapy, chemotherapy, or best supportive care (BSC). Related to this, the third study discusses the independent impact of metastasectomy on survival of STS patients with metachronous metastases. Of 135 patients included in a bi-centre study, 68 underwent metastasectomy, whilst the remaining 67 patients had been treated by radiotherapy, chemotherapy, or BSC. Using inverse-probability-weighting to account for “treatment-selection” bias regarding metastasectomy vs. non-operative treatment, an independent benefit of metastasectomy on patients’ survival was observed, with 1- and 10-year survival rates of 86% and 17%, respectively, for surgically treated patients as compared with 39% and 3% for non-operatively managed STS patients with metachronous metastasis. In the fourth article, an individual follow-up protocol for patients with extremity STS was developed within a multicentre study. The statistical models (flexible parametric competing risk regression models) developed on a test cohort of 1913 patients with intermediate or high-grade STS, and validated on an independent cohort of 1085 STS-patients, allow for assessment of patients’ individual risk for local recurrence and distant metastasis. The results of these models have been implemented in the PERSARC app that does not only enable prediction of cumulative local recurrence and distant metastasis risk, but also estimation of conditional risks for local and systemic spread from one follow-up appointment to the subsequent one in 3 or 6 months. International collaborations allow for better understanding of diagnosis, management, outcome, and follow-up of STS patients, eventually improving the overall outcome of patients affected by this rare and heterogeneous malignancy.

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