BACKGROUNDPrognostic factors for patients with soft‐tissue sarcoma who are treated with conservative surgery and radiation are documented poorly.METHODSThe clinicopathologic features and disease outcome for 1225 patients with localized sarcoma who were treated with conservative surgery and radiation were reviewed retrospectively. Actuarial univariate and multivariate statistical methods were used to determine significant prognostic factors for local control, metastatic recurrence, and disease specific survival.RESULTSThe median follow‐up of surviving patients was 9.5 years. The respective local control rates at 5 years, 10 years, and 15 years were 83%, 80%, and 79%. Factors predictive of local recurrence were positive or uncertain resection margins; tumors located in the head and neck and the deep trunk; presentation with local recurrence; patient age > 64 years; malignant fibrous histiocytoma, neurogenic sarcoma. or epithelioid sarcoma histopathology; tumor measuring > 10 cm in greatest dimension; and high pathologic grade. Freedom from metastasis at 5 years, 10 years, and 15 years was 71%, 68%, and 66%, respectively. Factors that were predictive of metastatic recurrence were high tumor grade; large tumor size (> 5 cm); and leiomyosarcoma, rhabdomyosarcoma, synovial sarcoma, or epithelioid sarcoma. The respective disease specific survival rates at 5 years, 10 years, and 15 years were 73%, 68%, and 65%. Adverse factors for disease specific survival were high tumor grade; large tumor size (> 5 cm); tumors located in the head and neck and deep trunk; rhabdomyosarcoma, epithelioid sarcoma, or clear cell sarcoma; patient age > 64 years; and positive or uncertain resection margins.CONCLUSIONSSoft‐tissue sarcoma comprises a heterogeneous group of diseases. Prognostic factors for local recurrence, metastatic recurrence, lymph node recurrence, disease free survival, and disease specific survival are different, and optimal treatment strategies need to take this complexity into account. Cancer 2003;10:2530–43. © 2003 American Cancer Society.DOI 10.1002/cncr.11365

The relationship between histopathology and tumor behavior was examined in 71 cases of chondrosarcoma. The tumors were grouped into Grades I, 11, and 111 on the basis of mitotic rate, cellularity, and nuclear size. The five-year survival rates of Grades I, 11, and 111 are 90%, 81%, and 43%, respectively, while the corresponding 10-year survival rates are 83%, 64%, and 29%. None of the Grade I chondrosarcomas metastasized, while metastasis was observed with 10% of the Grade I1 tumors and 71% of the Grade 111 tumors. No definite relationship between tumor grade and local recurrence was found. In addition, the significance of the extent of tlie original operative procedure was evaluated for chondrosarcoma, Grades I and 11. Local recurrence which could not be controlled by additional surgery occurred in 46% of the patients treated initially by local excision, but in only 9.5% of those who were treated by amputation or resection of all or part of the involved bone. It is concluded that chondrosarcomas range from locally aggressive non-metastasizing neoplasms to high-grade malignancies with marked metastatic potential, and that these groups may be defined and separated by the use of histopathologic criteria. The rate of local recurrence, however, is primarily dependent on the adequacy of surgical therapy rather than histologic grade.Cancer 40:818-831, 1977.HONDROSARCOMA IS A NEOPLASM WHICH HAS C long been known for the wide variability of its morphology and clinical course. Previous clinicopathologic evaluations of chondrosarcoma have shown that, in general, tumors of higher histologic grade are associated with shorter survival. "," However, the statistical significance of differences in survival rate by histologic grade has not been evaluated in most studies, and consistent correlation between histologic grade and the probability of metastasis has been lacking. This study was undertaken in an effort to

Forty-four cases of skin and soft tissue angiosarcoma seen at M. D. Anderson Hospital before 1976 were reviewed. The cases fell into six different clinical groups: scalp-face, 17 cases; postmastectomy, 14 cases; postradiation, 5 cases; leg with vascular stasis, 2 cases; breast, 2 cases; and miscellaneous, 4 cases. In all cases in the first four groups, the tumors involved primarily the dermis and subcutis and showed similar blends of vasoformative and solid histologic patterns. Two tumors in the miscellaneous group closely resembled those in the larger groups, but the other two in that group (both located in deeper soft tissue sites) and the two breast angiosarcomas had a somewhat different microscopic appearance. Survival was generally poor in all groups, owing to frequent local recurrence and early metastasis; median survival for the entire series was 20 months. Findings of significantly favorable prognostic importance were tumor size less than 5 cm (in the scalp-face group) and a moderate or marked lymphoid infiltrate in and around the tumor. Less significant favorable factors were a distal location ( in the postmastectomy group) and a low degree of pleomorphism. Only nine patients had long-term, disease-free survival.

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The clinical records and histopathologic features in 26 cases of extraskeletal osteosarcoma (ESOS) diagnosed at M.D. Anderson Cancer Center (Houston) between 1950 and 1987 were reviewed. Presentation was usually that of an enlarging soft tissue mass. The thigh (11 cases), upper extremity/shoulder girdle (three cases), and retroperitoneum (three cases) were the most common anatomic sites. Tumor size ranged from 2.5 to 30 cm. The predominant histologic pattern was osteoblastic in four cases, chondroblastic in two, fibroblastic or pleomorphic malignant fibrous histiocytoma (MFH)-like in four, giant cell type MFH-like in one, and small cell in one. Various mixtures of these patterns were seen in the remaining 14 tumors. The telangiectatic pattern was not seen as the predominant component in any primary tumor but was observed as a minor component. Thirteen tumors recurred locally and 16 metastasized; five patients had distant metastases at presentation. The lungs, bone, and soft tissue were the most frequent metastatic sites. Sixteen patients died of disease at 2 to 54 months, one patient died of unrelated causes at 61 months, seven patients were alive with no evidence of disease (NED) at 30 to 122 months, and two patients were alive with disease at 28 and 54 months, respectively. Tumor size (less than 5 cm versus greater than or equal to 5 cm) was the main prognostic factor; all patients alive with NED for whom accurate tumor measurements were available (six of seven) had neoplasms measuring less than 5 cm that were amenable to complete surgical excision. Histologic pattern and other clinicopathologic features did not significantly affect outcome.

Two deceptively benign-appearing, unclassifiable but very similar fibromyxoid sarcomas characterized histologically by bland, innocuous-appearing fibroblastic cells and a swirling, whorled growth pattern are presented. The tumors both occurred in women in their late twenties and were located in the soft tissues of the scapular area and the axillary-chest wall area, respectively. Lung metastases developed in both cases; one patient died 94 months after excision of the primary neoplasm, whereas the other was alive at 82 months. The designation "low-grade fibromyxoid sarcoma" is suggested for these tumors.

Twenty cases of head and neck mucosal squamous cell carcinoma containing a prominent sarcomatoid element were reviewed with special attention to possible prognostic factors. Patients whose tumors invaded muscle, minor salivary or accessory respiratory glands, or bone had very poor survival rates, whereas those whose tumors were superficial and did not extend into any of these structures had excellent survival rates. A history of irradiation to the tumor site and tumor location in the oral cavity rather than the larynx, pharynx, nasal cavity, or nasal-associated structures were associated with invasiveness and thus with poorer survival. Aside from invasion, histologic features and gross configuration were not found to be of significant prognostic importance.