• Dario Callegaro, Francesco Barretta, Chandrajit P Raut, Wendy Johnston, Dirk C Strauss, Charles Honoré, Sylvie Bonvalot, Mark Fairweather, Piotr Rutkowski, Winan J van Houdt, Rebecca A Gladdy, Fabio Tirotta, Dimitiri Tzanis, Jacek Skoczylas, Rick L Haas, Rosalba Miceli, Carol J Swallow, and Alessandro Gronchi.
• Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
• Ann. Surg. 2024 May 1; 279 (5): 857865857-865.

ObjectiveTo update the current Sarculator retroperitoneal sarcoma (RPS) prognostic nomograms considering the improvement in patient prognosis and the case volume effect.BackgroundSurvival 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.MethodsAll 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).ResultsThe 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.ConclusionsNew nomograms for patients with primary RPS treated with surgery at high-volume versus low-volume sarcoma reference centers are available in the Sarculator app.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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