E430: Timing and Frequency of Surveillance After Resection of Extremity and Trunk Soft-Tissue Sarcoma – Identifying Opportunities for Improvement

ePoster Abstract Author(s)

Neha Malik, MD, MS (she/her/hers)

Research Resident
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, United States

Submitter(s)

Neha Malik, MD, MS (she/her/hers)

Research Resident
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, United States

Author(s)

Neha Malik, MD, MS (she/her/hers)

Research Resident
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, United States
RT

Raymond Traweek, MD

Research Resident
The University of Texas MD Anderson Cancer Center, United States
Heather G. Lyu, MD, MBI

Assistant Professor
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, United States
RW

Russell Witt, MD

Assistant Professor in Surgery
University of Virginia, United States
AM

Alexander F. Mericli, MD

Associate Professor
MD Anderson, United States
YC

Yi-Ju Chiang, MSPH

Statistician
The University of Texas MD Anderson Cancer Center, United States
Samuel H. Cass, MD

Research Resident
The University of Texas MD Anderson Cancer Center
Dickinson, Texas, United States
Christopher P. Scally, M.D.

Assistant Professor
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA, United States
HL

Heather Lillemoe, MD

Assistant Professor of Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Keila E. Torres, MD

Associate Professor
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Kelly K. Hunt, MD (she/her/hers)

Professor & Chair
Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
Houston, Texas, United States
Emily Z. Keung, MD (she/her/hers)

Assistant Professor of Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Christina L. Roland, MD MS

Associate Professor of Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Introduction: Surveillance practices after resection of extremity and truncal soft-tissue sarcoma (ETSTS) vary, with guidelines recommending physical exam and imaging every 3-6 months. However, local and distant recurrence risks differ based on clinicopathological features including tumor grade and histopathologic subtype. The aim of this study was to evaluate surveillance patterns after ETSTS resection at our high-volume sarcoma referral center and determine if opportunities exist to de-escalate intensity of surveillance in appropriate patients.

Methods: A retrospective review of patients with primary ETSTS who underwent resection and surveillance at our institution from 2016-2021 was performed. Patients with low-grade sarcomas and/or less than 2 years of follow-up after resection were excluded. SARCULATOR, a validated nomogram for soft-tissue sarcoma, was used to stratify patients into high- (< 60%) and lower-risk (>/=60%) prognostic groups based on their predicted overall survival (OS) at 10 years. Descriptive statistics were used to show the distribution of variables within the cohort.

Results: The overall cohort of 260 p</span>atients included 113 high- and 147 lower-risk. Median follow-up after surgery was 4 years (range 2.5-5.2) and did not differ between high- and lower-risk groups (p=0.69). P</span>atients with high-risk ETSTS were older (median age at diagnosis 67 vs 53 years, p< 0.001) and had high-grade tumors (90% vs 65%, p< 0.001) (Table 1). As expected, p</span>atients with high-risk ETSTS had shorter 5-year OS compared to those with lower-risk ETSTS (73% vs 92%, p< 0.001). The 5-year recurrence-free survival was 77% for high-risk and 81% for lower-risk patients (p =0.33) and most patients in both high- and low-risk groups did not recur during the study period (82% vs 85%, p=0.61). Although 87% of patients in both risk groups underwent q3 month surveillance after surgery, the median time to recurrence was 22 months and was similar between risk groups (p=0.68) and only 36% of those that recurred did so within 1 year.

Conclusions: Although the majority of patients were surveyed every 3 months following resection of primary ETSTS, most did not recur or recurred beyond 1 year after surgery. In both high- and lower-risk groups, more intensive surveillance in the first year after surgery may not significantly impact identification or treatment of ETSTS recurrence or patient outcomes.

Learning Objectives:

understand the importance of surveillance in the extremity and truncal soft-tissue sarcoma patient population
evaluate surveillance patterns at their own institutions
determine if the intensity of surveillance following resection is necessary