The role of perioperative chemotherapy in primary high-grade extremity soft tissue sarcoma: a risk-stratified analysis using PERSARC

Ibtissam Acem*, Winan J van Houdt, PERSARC research group, Dirk J Grünhagen, Winette T A van der Graaf, Anja J Rueten-Budde, Hans Gelderblom, Cornelis Verhoef, Michiel A J van de Sande

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
40 Downloads (Pure)


OBJECTIVE: The aim of the study is to assess the effect of perioperative chemotherapy (CTX) in patients with grade II-III extremity soft tissue sarcoma (eSTS) on overall survival (OS) and evaluate whether the PERSARC prediction tool could identify patients with eSTS more likely to benefit from CTX.

METHODS: Patients (18-70 years) with primary high-grade eSTS surgically treated with curative intent were included in the retrospective cohort study. The effect of any perioperative CTX and anthracycline + ifosfamide (AI)-based CTX on OS was investigated in three PERSARC-risk groups (high/intermediate/low). The PERSARC-risk groups were defined by the 33% and 66% quantile of the predicted 5-year OS of the study population equal to a 5-year OS of 65.8% and 79.8%, respectively. The effect of CTX on OS was investigated with weighted Kaplan-Meier curves and multivariable Cox models with an interaction between risk group and CTX.

RESULTS: This study included 5683 patients. The weighted Kaplan-Meier curves did not demonstrate a beneficial effect of any CTX and AI-based CTX on OS in the overall population. However, in the high PERSARC-risk group the 5-year OS of AI-based CTX was significantly better than no CTX (69.8% vs 59.0%, respectively, p = 0.004) (HR 0.66, 95%CI 0.53-0.83).

CONCLUSIONS: This study demonstrated a beneficial effect of AI-based CTX on OS in a selected group of high-risk patients with an absolute survival benefit of 11% as stratified by the PERSARC prediction tool. However, no beneficial effect of CTX on OS was found in the overall population of patients with primary high-grade eSTS younger than 70 years.

Original languageEnglish
Pages (from-to)71-80
Number of pages10
JournalEuropean journal of cancer (Oxford, England : 1990)
Early online date24 Feb 2022
Publication statusPublished - 1 Apr 2022

Bibliographical note

Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Publisher Copyright:
© 2022 The Author(s)


Dive into the research topics of 'The role of perioperative chemotherapy in primary high-grade extremity soft tissue sarcoma: a risk-stratified analysis using PERSARC'. Together they form a unique fingerprint.

Cite this