Analysis of the Prognostic Significance of Microscopic Margins in 2,084 Localized Primary Adult Soft Tissue Sarcomas

Abstract

ObjectiveTo define the significance of positive microscopic resection margins in a large cohort treated for soft tissue sarcoma. MethodsThe authors analyzed 2,084 patients with localized primary soft tissue sarcoma (all anatomic sites) treated from 1982 to 2000. Clinicopathologic variables studied included tumor site, size, depth, histologic type, grade, and resection margin status. Treatment other than resection was not analyzed. Study endpoints included local and distant recurrence-free and diseasespecific survival rates, estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using the log-rank test and the Cox proportional hazards model. ResultsMedian follow-up was 50 months. After primary resection, 1,624 (78%) patients had negative and 460 (22%) had positive resection margins. Having positive margins nearly doubled the risk of local recurrence and increased the risk of distant recurrence and disease-related death. Seventy-two percent of patients with positive margins had no recurrence. Resection margin did not predict local control for retroperitoneal sarcomas or fibrosarcomas. Resection margin remained significantly associated with distant recurrence-free survival and disease-specific survival across all subsets after adjusting for other prognostic variables. The overall 5-year disease-specific survival rates for negative and positive margins were 83% and 75%. ConclusionsPositive microscopic resection margins significantly decrease the local recurrence-free survival rate for other-than-primary fibrosarcoma and retroperitoneal sarcomas, and independently predict distant recurrence-free survival rates and disease-specific survival rates for all patient subsets. Adjuvant therapy should be considered in the management of soft tissue sarcoma to increase local control. Because 72% of positive margins did not equate with inevitable local recurrence, considerable clinical judgment is required in considering additional treatment. Microscopic resection margins should be considered for inclusion in staging systems and treatment algorithms that address local recurrence.

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

“…Some of these studies included all tumor grades, superficial and deep tumors as well as trunk wall and retroperitoneal tumors. The median time to local recurrence in this study of 13 months was in line with the majority of the literature that reports local recurrences occurring in the first 2 to 3 years [18,36,51,56]. A positive microscopic surgical resection margin status did not have an adverse effect on local recurrence rates; however, as a result of the small number of local recurrences, a definitive conclusion could not be drawn from this.…”

“…This was equal to or lower compared with previous studies (22%-49%) [4,22,25,36,37,43,51,55,56,58,65]. Margin status did not have a statistically negative effect on the rate of metastases; however, given the small number of R1 margins, a conclusion cannot be drawn from this either.…”

“…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.…”

“…Eighteen patients were lost to followup and 37 did not have up to 24 months of followup or died before that. Most local recurrences occur within 2 to 3 years after resection [18,36,51,56]. Thus, we included 59 patients in the study.…”

“…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].…”