The prognostic value of pathological response in soft tissue sarcoma: A systematic review
In brief
Tumor response failed to reliably predict survival across 27 soft tissue sarcoma studies
In a review of 3,961 patients, low residual tumor, tumor necrosis, and scar-like tissue showed inconsistent links to survival after neoadjuvant treatment. Most studies did not adjust for key factors such as tumor type and grade, and response definitions varied widely, so pathological response is not yet a reliable prognostic guide; standardized assessment is needed.
- Journal
- Cancer treatment reviews (Q1)
- Published
- 1 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Bauke H G van Riet, Stijn J C van der Burg, Tom van der Klaauw, Neeltje Steeghs, Judith V G M Bovée, Astrid N Scholten, et al.
- PMID
- 42868891
- DOI
- 10.1016/j.ctrv.2026.103219
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 18 October 2026): Pathological response in soft‑tissue sarcoma systematic review
Abstract
BACKGROUND: Pathological response (pR) has increasingly been used as a surrogate marker of neoadjuvant treatment efficacy in soft tissue sarcoma (STS), yet evidence linking it to improved survival remains inconsistent. This review evaluates the prognostic value of pR in neoadjuvant-treated STS. METHODS: A systematic literature review identified clinical trials, observational studies, and retrospective studies assessing survival outcomes associated with pR, defined by residual viable tumour cells (RVT), necrosis, or fibrosis/hyalinization, in STS treated with neoadjuvant chemotherapy, radiotherapy, or chemoradiotherapy. Results were reported narratively given substantial heterogeneity between studies. RESULTS: Twenty-seven studies comprising 3961 patients (median 112, range 50-496) were included. Twenty-five reported RVT, eight necrosis, and seven fibrosis/hyalinization. Considerable variability was observed in the prognostic value of pR across studies. Low RVT predicted improved survival in 36% (9/25), high necrosis predicted decreased survival in 75% (6/8), and fibrosis/hyalinization was inconsistent (43% favourable, 29% unfavourable). Cut-off values, histological parameters and definitions, and patient and treatment characteristics varied widely. Analyses were predominantly unadjusted for confounders, including tumour grade, histological subtype, and resection margin. CONCLUSIONS: Current evidence is insufficient to support pR as a reliable prognostic predictor. The prognostic value of RVT, necrosis, and fibrosis/hyalinization varies substantially across studies, likely reflecting differences in histological subtype, tumour biology, treatment heterogeneity, and methodological inconsistencies in pR assessment. Standardisation of histological parameters assessed, their definitions, and pR categorisation criteria is required to determine the prognostic relevance of pR in STS. The proposed CHIRE framework provides a practical foundation for harmonising pR assessment and reporting in future STS studies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.