Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities.

Abstract

The independent adverse prognostic factors for distant recurrence and disease specific survival differ from those identified for subsequent local recurrence. Patients with microscopically positive surgical margins or patients who present with locally recurrent disease are at increased risk for subsequent local recurrence and tumor-related mortality. Specific histopathologic subtypes are associated with increased risks for local failure and tumor-related mortality.

Adult Soft Tissue Sarcoma Local Recurrence After Adjuvant Treatment Without Resection of Core Needle Biopsy Tract

“…There were five local recurrences (9%) among our patients, which was lower than numerous studies that evaluated local recurrences in patients with soft tissue sarcomas (13%-39%) [4,22,25,36,37,43,51,55,56,58,65]. Some of these studies included all tumor grades, superficial and deep tumors as well as trunk wall and retroperitoneal tumors.…”

“…Areas with macroscopic tumor close to the margin were sent for microscopic analysis. During retrospective review, margins that were free from tumor by [ 5 mm were defined as R0, R1 margins were equal to or less than 5 mm to the inked surface, whereas R2 margins were macroscopically positive for tumor [43]. There were 52 R0 resection margins, seven R1 margins, and no R2 margins.…”

“…Historically reported rates of local recurrence of soft tissue sarcomas range from 13% to 29% and metastases from 22% to 49% [4,22,25,36,37,43,51,55,56,58,65]. The addition of radiation to the wide resection of sarcomas improves local recurrence rates from 19% to 30% in certain studies, even in patients with microscopically positive margins [3,12,16,27,30,52,53,60,62].…”

Retroperitoneal soft tissue sarcomas

“…However, although the procedure easily may miss its objective in the former group, it may be crucial in the latter group. Unfortunately, the role of radiation therapy, the adjuvant effectiveness of which has been demonstrated for patients with STS of the limb, 21,27 is limited by the difficulty in delivering adequate doses to the retroperitoneum and the abdomen. In this regard, there are ongoing trials of preoperative radiation associated with a perioperative (intraoperative or postoperative) boost.…”

44th Maude Abbott Lecture

“…Although one might surmise that local recurrence in a highrisk sarcoma would be associated with distant metastasis because it would serve as a source of metastasis, this point has been controversial. Some studies have been unable to show significant differences in metastasis between patients who have had or not had a local recurrence, whereas others contend that there is an association (30,31) but that it is likely noncausal (29,32) and simply serves as a surrogate marker of a more aggressive tumor (29). There is no dispute, however, that distant metastasis is the primary reason that patients succumb to their tumor.…”