ESTRO 2024 - Abstract Book

S2122

Clinical - Sarcoma, skin cancer, melanoma

ESTRO 2024

Purpose/Objective:

Patients with high-grade non metastatic soft tissue sarcoma (STS) receiving curative treatment might develop distant relapse in approximately half of cases. It has been postulated that an inflammatory state, in solid tumors, may be associated with an aggressive disease course. Immune inflammation biomarkers calculated from routine blood count may represent a simple and useful tool for prognostic stratification. We evaluated the use of immune inflammatory markers in patients eligible for preoperative treatment and surgery.

Material/Methods:

Clinical and treatment-related data from patients treated at our institution with preoperative chemoradiation (50 Gy in 25 fraction combined with 3 cycles of Epirubicin-Ifosfamide) and surgery for high grade (FNCLCC 3) non metastatic STS patients were collected. For each patient the neutrophil-to-lymphocyte ratio (NLR), platelet-to lymphocyte ratio (PLR) and systemic immune- inflammation index (SII = NLR × platelets) from pretreatment blood samples were calculated. Only the biomarker with the higher AUC for distant relapse was included in survival analysis: optimal cutoff value in terms of sensitivity and specificity was obtained based on Youden-J index. Distant Metastases Free Survival (DMFS) and Overall Survival (OS) were calculated using the Kaplan Meier method; univariate analysis (UVA) with the log-rank test and multivariate analysis (MVA) were performed to assess correlation between variables and outcome.

Results:

Forty-nine STS patients treated with preoperative chemoradiation were included. Median age was 55 years (range 19-83). All patients completed the preoperative treatment regimen and underwent wide excision. Median NLR, SII and PLR were 3 (1-20), 748 (194-6065) and 141(54-769) respectively. ROC curve analysis for distant relapse showed better performance for NLR (AUC: 0.692) as compared to SII (AUC:0.67) and PLR (AUC:0.588). A Youden-J at threshold of >3 (Specificity:63.6%; Sensitivity:70.4%) was chosen as cut-off for NLR (fig.1). At the time of our analysis, after a median follow-up of 28 months, distant relapse and death occurred in 22 and 16 patients, respectively. One and 3-year DMFS was 66% and 42% respectively, while 1- and 3-years OS was 88% and 67% respectively. At UVA, only an NLR>3 was correlated with impaired DMFS (median 8 months vs NR, p=0.0054), while NLR>3 (median 29 months vs NR, p=0.0007), PS= 2 (median 3 months vs NR, p=0.0002) and trunk tumor location (median 26 vs NR, p=0.025) were correlated with OS. At MVA both NLR>3 (p=0.006) and PS= 2 (0.031) were independently associated with survival (fig.2).