The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

Liang, Yao; Guo, Tianhui; Xu, Bu-Shu; Hong, Dong-Chun; Qiu, Haibo; Zhou, Zhiwei; Zhang, Xing

doi:10.3389/fonc.2020.617590

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…22,45 Worse oncologic outcomes in these patients may be attributed to (1) failure to resect the mass en bloc with negative surgical margins, and (2) the limitations of relying solely on margins for local control in cases of unplanned excision. 25,33 Potter et al 32 Our study found that tumor grade and size were predictors of metastatic development in foot and ankle STS, consistent with existing STS literature. 24 Notably, history of unplanned excision, a risk factor for local recurrence, was not associated with an increased risk of metastasis.…”

Section: Discussionsupporting

confidence: 88%

“…22,45 Worse oncologic outcomes in these patients may be attributed to (1) failure to resect the mass en bloc with negative surgical margins, and (2) the limitations of relying solely on margins for local control in cases of unplanned excision. 25,33 Potter et al 32 demonstrated that patients with either microscopic or gross residual disease at tumor bed excision had lower 5-year local recurrence–free survival than those with no residual disease, regardless of surgical margins. Therefore, surgeons should consider both surgical margins and the presence of residual tumor during tumor bed excision as important predictors of local recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Foot and Ankle Soft Tissue Sarcomas–Treatment and Oncologic Outcomes: A Systematic Review of the Literature

Fanfan,

Alvarez,

Gonzalez

et al. 2023

Foot Ankle Int.

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Background: Foot and ankle soft tissue sarcomas (STSs) are rare neoplasms associated with a high risk of local recurrence and metastasis. Although amputation is often performed, its impact on prognosis remains unknown. The aims of our systematic review were identifying risk factors for (1) disease-specific death, (2) local recurrence, (3) metastasis, and assessing (4) whether the type of surgery (amputation or limb-salvage) affected disease-specific survival. Methods: This systematic review was conducted following PRISMA guidelines. The PubMed, Embase, and Scopus databases were searched. Our study was registered in PROSPERO (ID: 415624). Quality appraisal was done using STROBE guidelines. Results: A total of 7 studies and 123 patients were included. Metastasis was the only risk factor for disease-specific death (OR = 107.85, P< .001). Previous unplanned excision (OR = 22.29, P = .009) and positive margins (OR = 64.48, P = .011) were associated with higher risk of local recurrence. Patients with high-grade tumors (OR = 13.22, P = .023) and tumors ≥6 cm (OR = 7.40, P = .022) were more likely to develop metastases. After adjusting for confounders (age, sex, and presence of metastasis), amputation was not associated with poorer disease-specific survival. Conclusion: Metastasis was the single most important risk factor for death with foot and ankle soft tissue sarcoma. Positive margins and history of previous unplanned excision are risk factors for local recurrence. The most important risk factors for metastasis are tumor grade and size ≥6 cm. Amputation was not associated with poorer disease-specific survival.

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Section: Discussionsupporting

confidence: 88%

“…22,45 Worse oncologic outcomes in these patients may be attributed to (1) failure to resect the mass en bloc with negative surgical margins, and (2) the limitations of relying solely on margins for local control in cases of unplanned excision. 25,33 Potter et al 32 demonstrated that patients with either microscopic or gross residual disease at tumor bed excision had lower 5-year local recurrence–free survival than those with no residual disease, regardless of surgical margins. Therefore, surgeons should consider both surgical margins and the presence of residual tumor during tumor bed excision as important predictors of local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Foot and Ankle Soft Tissue Sarcomas–Treatment and Oncologic Outcomes: A Systematic Review of the Literature

Fanfan,

Alvarez,

Gonzalez

et al. 2023

Foot Ankle Int.

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“…Many studies describe a similarly greater proportion of high-grade tumors among UE patients, ranging from 69% to 95%. 14 , 17 , 22 , 24 , 27 Chandrasekar et al 18 noted a higher rate of LR among high-grade tumors and those excised with close surgical margins; similar to the findings of this study where both variables are negative predictors for LR. These observations may explain the larger number of high-grade tumors on presentation among the UE group.…”

Section: Discussionsupporting

confidence: 87%

Unplanned Excision of Soft Tissue Sarcomas of the Extremities in a Low-to-Middle-Income Country

et al. 2023

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Background Outcomes of unplanned excisions of extremity soft tissue sarcomas (STSE) range from poor to even superior compared with planned excisions in developed countries. However, little is known regarding outcomes in low-to-middle-income countries. This study aimed to determine whether definitively treated STSE patients with a previous unplanned excision have poorer oncologic outcomes compared with those with planned excisions. Patients and Methods Using the database of a single sarcoma practice, we reviewed 148 patients with STSE managed with definitive surgery-78 with previous unplanned excisions (UE) and 70 with planned excisions (PE). Results Median follow-up was 4.4 years. UE patients had more surgeries overall and plastic reconstructions ( P < 0.001). On multivariate analysis, overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were not worse among UE patients compared with PE patients. Negative predictors for LRFS were high tumor grade ( P = 0.031) and an R1 surgical margin ( P < 0.001). High grade ( P <0.001), local recurrence ( P = 0.001), and planned excisions ( P = 0.009) predicted poorer DMFS, while age over 65 years ( P = 0.011) and distant metastasis predicted poorer OS ( P < 0.001). Conclusions We recommend systematic re-excision for patients with unplanned excisions. Our study shows that STSE patients with UE, when subjected to re-excision with appropriate surgical margins, can achieve oncologic results similar to those for PE patients. However, there is an associated increased number of surgeries and plastic reconstruction for UE patients. This underscores the need, especially in a resource-limited setting, for education and collaborative policies to raise awareness about STSE among patients and physicians.

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“…Others [22][23][24][25] demonstrated similar or even better LRFS, disease-free survival (DFS), and MFS in patients who underwent R0 re-operation after unplanned excision compared to those with planned definitive resection. Liang et al [26] found that unplanned excision followed by R0 resection decreased the risk of local recurrence and is an independent factor of local recurrence.…”

Section: Extremity and Trunk Wall Sarcomasmentioning

confidence: 99%

How I Treat Localized Soft Tissue Sarcomas: Update on Diagnosis, Risk Stratification, and Treatment

et al. 2022

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Background: Adult-type soft tissue sarcomas (STS) are rare tumors representing about 1% of all adult malignant tumors. Their extreme histological heterogeneity places them among the most challenging fields of diagnostic pathology. The variability of clinical and prognostic presentation between the various histotypes reflects the different management that should be followed on a case-by-case basis. These features make soft tissue sarcomas the case in point of how important it is a centralized and multidisciplinary approach. Summary: Surgery represents the mainstay in the treatment of localized soft tissue sarcomas. Recently, more and more studies are making efforts to understand what the contribution of chemotherapy and radiotherapy with neoadjuvant and adjuvant intent may be both in unselected and selected histological subgroups. In fact, despite the improvement in overall survival seen in the past few years thanks to the adoption of a more radical surgical approach, mortality remains relatively high and the five-year overall survival is around 65%. Key messages: In this review, we comment upon the treatment of localized soft tissue sarcomas of the extremity, trunk wall and retroperitoneum and how surgery, radiotherapy and chemotherapy can be integrated with each other and individually tailored. Nomograms can assist clinicians in this complex therapeutic-decision making process, through the identification of patients at higher risk of death or disease relapse.

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The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

Cited by 13 publications

References 32 publications

Foot and Ankle Soft Tissue Sarcomas–Treatment and Oncologic Outcomes: A Systematic Review of the Literature

Foot and Ankle Soft Tissue Sarcomas–Treatment and Oncologic Outcomes: A Systematic Review of the Literature

Unplanned Excision of Soft Tissue Sarcomas of the Extremities in a Low-to-Middle-Income Country

How I Treat Localized Soft Tissue Sarcomas: Update on Diagnosis, Risk Stratification, and Treatment

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