Pathological response after neoadjuvant therapy in soft tissue sarcoma: A systematic review of its association with local recurrence, distant metastasis, and survival.
Francesco Saverio Papadia, Danila Comandini, Matteo Mascherini et al.
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In 30 seconds
This systematic review assessed whether pathological response after neoadjuvant treatment predicts oncological outcomes in adults with localized soft tissue sarcoma treated with surgery. Nineteen studies included 2346 unique patients. Pathological complete response rates ranged from 0% to 29%, but associations between response measures and outcomes were inconsistent: residual viable tumour and EORTC-STBSG categories showed no reproducible association, while findings for necrosis, fibrosis and hyalinization varied. The authors conclude that no pathological-response measure is sufficiently validated to guide routine management.
Key findings
- Across 19 studies and 2346 unique patients, pathological complete response rates ranged from 0% to 29%.
- Residual viable tumour and EORTC-STBSG response categories showed no reproducible association with oncological outcomes.
- Necrosis was non-prognostic or paradoxically associated with worse outcomes; fibrosis and hyalinization had conflicting associations.
- Sclerohyalinosis greater than 20% was associated with improved disease-free survival in one prospective trial, but needs independent validation.
Why it matters
Pathological response is used as a prognostic concept in bone sarcoma, but this review indicates that its meaning in soft tissue sarcoma depends on the specific histological parameter assessed. Inconsistent associations and low or very low certainty of evidence limit its reliability for estimating outcomes. Separately reporting response components may support clearer research and future histotype-specific validation.
What to keep in mind
The evidence was low certainty for pathological complete response and sclerohyalinosis, and very low certainty for necrosis and fibrosis/hyalinization. The sclerohyalinosis finding came from one prospective trial and requires independent validation.