Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 1;279(5):857-865.
doi: 10.1097/SLA.0000000000006098. Epub 2023 Sep 27.

New Sarculator Prognostic Nomograms for Patients With Primary Retroperitoneal Sarcoma: Case Volume Does Matter

Dario Callegaro  1 , Francesco Barretta  2 , Chandrajit P Raut  3 , Wendy Johnston  4 , Dirk C Strauss  5 , Charles Honoré  6 , Sylvie Bonvalot  7 , Mark Fairweather  3 , Piotr Rutkowski  8 , Winan J van Houdt  9 , Rebecca A Gladdy  10   11 , Fabio Tirotta  5   12 , Dimitiri Tzanis  7 , Jacek Skoczylas  8 , Rick L Haas  13 , Rosalba Miceli  2 , Carol J Swallow  10   11 , Alessandro Gronchi  1
Affiliations

New Sarculator Prognostic Nomograms for Patients With Primary Retroperitoneal Sarcoma: Case Volume Does Matter

Dario Callegaro et al. Ann Surg. .

Abstract

Objective: To update the current Sarculator retroperitoneal sarcoma (RPS) prognostic nomograms considering the improvement in patient prognosis and the case volume effect.

Background: Survival of patients with primary RPS has been increasing over time, and the volume-outcome relationship has been well recognized. Nevertheless, the specific impact on prognostic nomograms is unknown.

Methods: All consecutive adult patients with primary localized RPS treated at 8 European and North American sarcoma reference centers between 2010 and 2017 were included. Patients were divided into 2 groups: high-volume centers (HVC, ≥13 cases/year) and low-volume centers (LVC, <13 cases/year). Primary end points were overall survival (OS) and disease-free survival (DFS). Multivariable analyses for OS and DFS were performed. The nomograms were updated by recalibration. Nomograms performance was assessed in terms of discrimination (Harrell C index) and calibration (calibration plot).

Results: The HVC and LVC groups comprised 857 and 244 patients, respectively. The median annual primary RPS case volume (interquartile range) was 24.0 in HVC (15.0-41.3) and 9.0 in LVC (1.8-10.3). Five-year OS was 71.4% (95% CI: 68.3%-74.7%) in the HVC cohort and 63.3% (56.8%-70.5%) in the LVC cohort ( P =0.012). Case volume was associated with both OS (LVC vs. HVC hazard ratio 1.40, 95% CI: 1.08-1.82, P =0.011) and DFS (hazard ratio 1.93, 95% CI: 1.57-2.37, P <0.001) at multivariable analyses. When applied to the study cohorts, the Sarculator nomograms showed good discrimination (Harrell C index between 0.68 and 0.73). The recalibrated nomograms showed good calibration in the HVC group, whereas the original nomograms showed good calibration in the LVC group.

Conclusions: New nomograms for patients with primary RPS treated with surgery at high-volume versus low-volume sarcoma reference centers are available in the Sarculator app.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the Multi-institutional Collaborative RPS Working Group. Ann Surg. 2016;263:1002–1009.
    1. Gronchi A, Miceli R, Shurell E, et al. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol. 2013;31:1649–1655.
    1. Callegaro D, Miceli R, Gladdy RA. Prognostic models for RPS patients—attempting to predict patient outcomes. J Surg Oncol. 2018;117:69–78.
    1. Raut CP, Miceli R, Strauss DC, et al. External validation of a multi-institutional retroperitoneal sarcoma nomogram. Cancer. 2016;122:1417–1424.
    1. Chou YS, Liu CY, Chang YH, et al. Prognostic factors of primary resected retroperitoneal soft tissue sarcoma: analysis from a single asian tertiary center and external validation of gronchi’s nomogram. J Surg Oncol. 2016;113:355–360.