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Sarcoma

E422: Adult soft tissue sarcomas in Mexico: Current national patterns of presentation, treatment, and oncologic outcomes

Introduction: The complexity of soft tissue sarcomas (STS) results in diagnostic delay, suboptimal treatment and poor outcomes. There is no current national epidemiologic information on adult STS in Mexico, with recent studies limited largely to single centers. Mexican guidelines predate treatment and prognostic differences affecting clinical practice among STS subtypes. We described patterns of presentation, histology and treatment of adult patients with STS in Mexico.

Methods: National retrospective analysis including 17 Mexican Sarcoma Group institutions in 9 states. Primary, recurrent or metastatic adult STS treated from 2012-2022 were included. Clinical, histological, treatment and follow-up data were analyzed. 5-year local recurrence-free (LRFS), distant metastasis-free (DMFS) and disease-specific survival (DSS) were calculated.

Results:

Among 1186 included patients, 87.1% underwent surgery and 88.6% presented as primary localized disease. Preoperative biopsy was done in 37.3% of 592 extremity, 37.2% of 432 abdomen/retroperitoneum (ARP), 44% of 26 head & neck (HN) and 56.9% of 49 trunk STS (p=0.001). Extent of resection is shown in Fig 1. In extremity, the most frequent histologies were synovial (SS, n=91), well-differentiated liposarcoma (WDLPS, n=80), undifferentiated pleomorphic sarcoma (UPS, n=56) and de-differentiated liposarcoma (DDLPS, n=56). Margin status was R0 in 54.6%, R1 in 33.3% and R2 in 12% cases. Radiotherapy (RT) was given in 51% cases, 97% being adjuvant, while chemotherapy (CT) was given in 26.2% cases, 82.2% adjuvant.

In ARP, most common histologies were WDLPS (n=94), DDLPS (n=71), LMS (n=51) and UPS (n=21). R0-R1 margins were obtained in 75.5% and R2 in 13.5%, being significantly different per histology (DDLPS 98.6%, LMS 71.4%, p=0.001). RT was given in 30.4% cases, adjuvant in 88.2%. CT was given in 28.4% cases, 77.8% adjuvant.

Overall DSS was 67% (SE±0.03, extremity 64%, ARP 75%, trunk 84%, HN 47%, p=0.025). In extremity, LRFS was 84% (SE±0.03, p=NS per histology). DMFS was 73% (SE±0.04), being lowest for UPS (46%, SE±0.14, p< 0.001). In ARP, LRFS and DMFS were 52% (SE±0.06) and 69% (SE±0.05), p=NS per histology.

Conclusions: Accurate epidemiologic data is necessary to assess the current state of sarcoma care in Mexico and identify gaps in recent standard of care practice changes. The establishment of a prospective national registry is key for measuring and improving quality in diagnosis and treatment of STS patients, rates of curative surgery, access to perioperative multimodal treatment, and survival.

Learning Objectives:

  • Recognize current patterns of presentation of soft tissue sarcomas in adult population in Mexico
  • Compare the extent of surgical resection by histology and anatomic location
  • Discuss perioperative treatment trends in extremity and abdominal/retroperitoneal soft tissue sarcomas in Mexico