Surgical Margin and Its Influence on Survival in Soft Tissue Sarcoma

Dickinson, Ian C.; Whitwell, Duncan; Battistuta, Diane; Thompson, Bridie S.; Strobel, Natalie; Duggal, Amit; Steadman, Peter

doi:10.1111/j.1445-2197.2006.03615.x

Cited by 105 publications

(110 citation statements)

References 29 publications

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Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…The study periods spanned the 1990s and/or 2000s, and dated back to the 1980s for 9 studies (Hsieh et al, 2003;Campbell et al, 2004;Hsu et al, 2004;Dickinson et al, 2006;Wu et al, 2006;Kim et al, 2007;2008c;Huang et al, 2010;Han et al, 2011) and the 1970s for 1 study (Wang et al, 2009) (Table 1). The number of patients [minimum, 12 (Jun et al, 2010); maximum, 324 (Dickinson et al, 2006) was fewer than 50 in 17 of the 32 studies. Only 13 studies specified whether STS was primary or recurrent [8 primary (Dickinson et al, 2006;Hui et al, 2006;Wu et al, 2006;An et al, 2007;Kim et al, 2008a;Ng and Tan, 2009;Wang et al, 2009;Liu et al, 2010); 5 primary or recurrent (Hsieh et al, 2003;Kiatisevi et al, 2006;Moncrieff et al, 2008;Miki et al, 2010;Cho et al, 2011)].…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…The number of patients [minimum, 12 (Jun et al, 2010); maximum, 324 (Dickinson et al, 2006) was fewer than 50 in 17 of the 32 studies. Only 13 studies specified whether STS was primary or recurrent [8 primary (Dickinson et al, 2006;Hui et al, 2006;Wu et al, 2006;An et al, 2007;Kim et al, 2008a;Ng and Tan, 2009;Wang et al, 2009;Liu et al, 2010); 5 primary or recurrent (Hsieh et al, 2003;Kiatisevi et al, 2006;Moncrieff et al, 2008;Miki et al, 2010;Cho et al, 2011)]. Patients had local disease in 15 studies (Choong et al, 2003;Campbell et al, 2004;Hsu et al, 2004;Dickinson et al, 2006;Hui et al, 2006;An et al, 2007;Kim et al, 2007;2008c;Pervaiz et al, 2008;Rudiger et al, 2009;Wang et al, 2009;Liu et al, 2010;Cho et al, 2011;Han et al, 2011), and local or metastatic disease in 7 studies (Wu et al, 2006;Chan et al, 2008;Moncrieff et al, 2008;Koh et al, 2009;Jun et al, 2010;Park et al, 2010;Lee et al, 2011).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Ngan¹,

Wang²,

Porter³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 14 (11), [6821][6822][6823][6824][6825][6826][6827][6828][6829][6830][6831][6832] Introduction Soft-tissue sarcomas (STS) are a heterogeneous group of rare tumours. More than 50 STS histotypes have been identified, with most having unique clinical, prognostic, and therapeutic features. Although less than 1% of all adult malignant tumours are STS (Fletcher et al., 2002a), their treatment and management is complex because many tumour-related (eg, histotype, site, size, depth, grade, primary vs recurrent) (Singer et al., 1994;2000;Pisters et al., 1996) and treatment-related (eg, surgical margins, use of adjuvant therapy) (Singer et al., 2000) factors influence patient outcomes. Because these factors are inherently variable and because STS is rare, the management of patients with STS is best undertaken by an experienced multidisciplinary team in specialist centres to minimise recurrence, maximise survival, and preserve functionality and quality of life (Ray-Coquard et al., 2004;Luis et al., 2010; National Comprehensive Cancer Network, 2012).The standard primary treatment for STS is surgical AbstractBackground: Soft-tissue sarcomas require tailored and multidisciplinary treatment and management. However, little is known about how sarcomas are treated and managed throughout the Asia-Pacific region. Materials and Methods: MEDLINE was systematically searched using prespecified criteria. Publications (previous 10 years) that reported tumour characteristics, treatment patterns, survival outcomes, and/or safety outcomes of patients with soft-tissue sarcoma were selected. Exclusion criteria were studies of patients <18 years of age; ≤10 patients; countries other than Australia, Hong Kong, Indonesia, Korea, Malaysia, New Zealand, Philippines, Singapore, Taiwan, or Thailand; >20% benign tumours; sarcomas located in bones or joints; gastrointestinal stromal tumour; Kaposi's sarcoma; or not reporting relevant outcomes. Results: Of the 1,822 publications retrieved, 35 (32 studies) were included. Nearly all patients (98%, 1,992/2,024; 31 studies) were treated with surgery, and more studies used adjuvant radiotherapy than chemotherapy (24 vs 17 studies). Survival outcomes and recurrence rates varied among the studies because of the different histotypes, sites, and disease stages assessed. Only 5 studies reported safety findings. Conclusions: These findings highlight the lack of specific data available about soft-tissue sarcomas in the Asia-Pacific region. Better efforts to understand how the sarcoma is managed and treated will help improve patient outcomes in the region.

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Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Ngan¹,

Wang²,

Porter³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Some authors believe a negative microscopic surgical margin enhances local disease control but does not measurably improve overall survival [3,4,28]. In contrast, recent reports argued surgical excision with negative margins not only improves local control but also enhances overall survival [9,23,27]. In one of the largest published series of 2084 patients, Stojadinovic et al [27] reported a positive margin nearly doubled the risk of local recurrence and increased the risk of distant metastasis and disease-related death [27].…”

Section: Introductionmentioning

confidence: 97%

“…Negative surgical margin, low histologic grade, and use of radiotherapy are the most important factors in achieving local disease control [6,8,10,12,23,27,30,33]. However, the effect of positive margin and local recurrence as independent prognostic factors for metastasis-free survival and overall survival is still a matter of debate [9,10,16,21,23,25,28,29].…”

Section: Introductionmentioning

confidence: 99%

Do Surgical Margin and Local Recurrence Influence Survival in Soft Tissue Sarcomas?

Novais

Demiralp

Alderete

et al. 2010

Clinical Orthopaedics &Amp; Related Research

138

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Background Established prognostic factors influencing survival in soft tissue sarcomas include tumor stage, histopathologic grade, size, depth, and anatomic site. The presence of tumor near or at the margin of resection increases the risk of local recurrence but whether a positive surgical margin or local recurrence affect overall survival is controversial. Questions/purposes We explored the impact of microscopic margin on local recurrence, metastasis, and overall survival in patients with intermediate-to high-grade soft tissue sarcomas of the extremities. We then determined whether local recurrence decreases overall survival. Methods We retrospectively reviewed the medical records of 248 patients who had soft tissue sarcomas of the extremities treated surgically from 1995 to 2008. We estimated survival, local recurrence, and distant metastasis and examined factors potentially influencing these outcomes. The minimum followup was 0.4 years (median, 4.4 years; range, 0.4-13 years). Results The 5-year cumulative incidence of local recurrence was 4.1%. Patients who presented with positive margins or a margin of 2 mm or less had a worse survival than patients who had margins of greater than 2 mm and wide margins (5-year survival, 47% versus 70% and 72%). In addition to surgical margin, developing metastasis, tumor response of less than 90% necrosis, high histopathologic grade, high AJCC stage (Stage III), increasing age, and male gender were associated with decreased overall survival. Local recurrence independently predicted decreased overall survival. Conclusions Microscopic surgical margin and local recurrence after surgical treatment should be included as risk factors predicting decreased overall survival for intermediate-to high-grade soft tissue sarcomas of the extremities. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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