Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: An international collaborative study

Abstract

BACKGROUND. Single‐institutional studies lack sufficient power to assess the role of surgery and radiotherapy in the management of sarcomas involving the anterior skull base. For this study, an international collaborative study group analyzed a large cohort of patients who underwent surgery for the treatment of skull base tumors. METHODS. A subset of 146 patients who had a histologic diagnosis of skull base sarcoma (SBS) formed the basis of this report. Most patients were aged ≥21 years (77%) and had stage IV disease (56%). Adjuvant radiotherapy was received by 35% of patients, and chemotherapy was received by 10% of patients. RESULTS. Orbital involvement was encountered in 53% of patients, involvement of the orbital wall was encountered in 46% of patients, and intracranial extension was encountered in 28% of patients. Positive microscopic margins were reported in 43% of patients (51 of 118 patients). Treatment‐related complications were reported in 27% of patients, and postoperative mortality was reported in 1.4% of patients. With a median follow‐up of 34 months, the 5‐year overall, disease‐specific, and recurrence‐free survival rates were 62%, 64%, and 57%, respectively. Tumor grade and adjuvant radiotherapy were not significant predictors of survival. Prior radiotherapy, intraorbital extension, positive margins, and postoperative complications were significant predictors of reduced disease‐specific survival on univariate analysis. The presence of positive/close margins, however, was the only independent predictor of poor overall, recurrence‐free, and disease‐specific survival on multivariate analysis (relative risk, 2.4; P = .006). The 5‐year disease‐specific survival rate was 77%, 43%, and 36% for patients with negative, close, and positive margins, respectively. CONCLUSIONS. The current results indicated that wide craniofacial resection with negative margins is an independent prognostic predictor of better outcome. Patients with positive margins have a high risk for tumor recurrence independent of tumor grade. Cancer 2007. © 2007 American Cancer Society.

Prognostic factors and treatment strategies for adult head and neck soft tissue sarcoma

“…Several authors agree that positive surgical margins are associated with poor prognoses. 13,17,20,23 In the present study, the presence of R1 or R2 margins was also related to the prognosis.…”

Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research

“…The univariate association between individual clinical features and survival was determined with the log-rank test (Mantel, 1966). A multivariate analysis using the Cox proportional hazards regression model was performed to compare the factors with prognostic potential as indicated by univariate analyses (Cox, 1972; Gil et al , 2007). The limit of significance for all analyses was defined as P <0.05; two-sided statistical tests were used in all calculations.…”

Craniofacial Resection and Reconstruction in Patients With Recurrent Cancer Involving the Craniomaxillofacial Region

“…3 Although the morbidity and mortality after craniofacial resection for anterior skull base SA are relatively low, these patients are at high risk for tumor recurrence, regardless of the tumor grade. 4 Despite its considerable challenges, craniofacial resection appears to be a safe and reasonably effective treatment modality for patients with malignant tumors involving the cranio-maxillofacial region. While there were no significant differences among the AND, AWD, and DOD groups, 28.6% of the SCC patients versus 10.0% of the SA patients died of local recurrence or distant metastases at 8-18 months.…”