Long-term outcome after local recurrence of soft tissue sarcoma: a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma

Abstract

Background:The aim of this study was to identify prognostic indicators of survival in patients with locally recurrent soft tissue sarcoma (STS) through a long-term follow-up.Methods:We retrospectively assessed the relationship between post-recurrence survival (PRS) and potential prognostic factors in 135 patients who had experienced local recurrence, which was suitable for further surgical treatment. The median follow-up time after initial recurrence was 12.3 years (95% confidence interval (CI): 10.4–14.2 years).Results:The 5-year estimate of the PRS rate was 53.1% (95% CI: 44.3–61.2%) for the entire series. Patients with negative margins after the final surgery experienced improved survival compared with patients with positive margins (5-year survival: 46.7% (35.2–57.5%) vs 35.5% (23.4–47.8%); P=0.01). In a multivariate analysis, the significant prognostic indicators for PRS were histologic grade, tumour site, time to initial recurrence, the number of recurrences and the surgical margin status attained at the last resection.Conclusions:Complete surgical resection with microscopically clear margins is desirable in patients with locally recurrent STS. However, when achieving clear surgical margins will require major functional impairment of the extremity, a radical surgical approach should be weighed for the patient in each case.

Soft Tissue Sarcomas of the Extremities: Surgical Margins Can Be Close as Long as the Resected Tumor Has No Ink on It

“…Negative margins could be attained in 71.2% and were associated with a significantly improved DSS, indicating the importance of surgical margins even after recurrence (five‐year DSS after resection of recurrence: 71.6% vs. 37.2%; p < .001). This finding is in line with a previous work by our institution that focused on the long‐term outcome of STS patients after recurrence .…”

Intraoperative optical coherence tomography for soft tissue sarcoma differentiation and margin identification

“…In a study by Shiu et al , out of 297 patients recruited for the study, 46% were returning with locally recurrent disease, while the remaining presented for initial therapy. Even higher recurrence rates (53.1%) have been previously reported . Current evaluation of STS relies on clinical history, evaluation, lesion location, determination of mineralization on radiographs, and signal intensity characterization on magnetic resonance images .…”

Management of soft tissue tumors of the upper extremity: a review

“…In accordance with this, Daigeler found similar survival between certain individuals with residual tumor compared to those with complete resection and negative margins [24]. Based on these findings, it seems negative margins provide long-term benefit in patients with locally recurrent soft tissue sarcomas, however achievement of negative margins at all costs (including amputation in cases where salvage is not possible) may not be necessary and should be tailored to individual cases [24]. …”