The Problem of Local Recurrence after Treatment of Soft Tissue Sarcoma

Cantin, Jacques; McNeer, Gordon; Chu, Florence C. H.; Booher, Robert J.

doi:10.1097/00000658-196807000-00005

Cited by 285 publications

(74 citation statements)

References 8 publications

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“…Previous studies on STS showed that the his tologic grade [5,13,14], location [5,15,16], size of prima ry tumor [1,5], and the method of initial surgical treat ment [17][18][19] were important factors affecting the fre quency of local recurrence. The local recurrence usually occurred within 2 years after initial surgery in the present series and reported cases of STS [20,21].…”

Section: Discussionsupporting

confidence: 48%

Usefulness of Argyrophilic Nucleolar Organizer Staining for Predicting Prognosis of Patients with Recurrent Soft Tissue Sarcoma

Kuratsu¹,

Ohsawa²,

Naka³

et al. 1994

Oncology

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Local recurrence of tumor is a common phenomenon in soft tissue sarcoma (STS) and may be accompanied by an increase in malignant potential. In the present study, an increase of proliferative activity in recurrent tumors compared to primary tumors was observed using a silver stain for nucleolar organizer regions (AgNOR), and its implication for predicting prognosis is assessed. 44 patients with STS showing local tumor recurrence were selected. Local recurrence was defined as new tumor growth more than 2 months after the initial surgery in the same region where the primary tumor occurred. All patients received surgery, followed in 11 patients by adjuvant radiotherapy and/or chemotherapy. The histologic subtype was malignant fibrous histiocytoma in 22 cases, synovial sarcoma in 5, leiomyosarcoma in 4, liposarcoma in 3, malignant schwannoma in 3, and others in 7. The interval between initial surgery and local recurrence ranged from 2 to 72 months. No patients changed from one histological subtype to another. Histological changes included an increase in mitosis, cellularity, and sclerosis in 43.2, 31.8, and 27.3%, respectively. The AgNOR count (mean ± SD) in recurrent tumors (7.22 ± 2.59) was significantly higher than that in primary tumors (5.58 ± 2.28; p < 0.0057), clearly showing a tendency for an increase in proliferative activity during recurrence. The 5-year survival rate of patients with a marked increase ( > 4) in AgNOR count (16.7%) was worse than with minor to moderate increases (60.0%; p < 0.02). Marked AgNOR increase was more frequently observed in the tumors located in the head and neck and retroperitoneum (40%) than in other sites (9%). Irrespective of the primary site of tumors, a marked AgNOR increase resulted in an unfavorable prognosis. Multivariate analysis of change in histologic factors including AgNOR, cellularity, mitotic counts, pleomorphism, myxoid change, necrosis, sclerosis, and tumor size showed that increase of AgNOR counts was significant (p < 0.05). The present findings suggest that AgNOR counts can be used as a prognostic factor in recurrent STS.

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Section: Discussionsupporting

confidence: 48%

Usefulness of Argyrophilic Nucleolar Organizer Staining for Predicting Prognosis of Patients with Recurrent Soft Tissue Sarcoma

Kuratsu¹,

Ohsawa²,

Naka³

et al. 1994

Oncology

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“…Distinguishing between local recurrence alone vs. local recurrence with synchronous distant micrometastases is difficult. The controversy between the association of local recurrence with subsequent survival has continued since the classic work of Cantin et al [14]. Of 653 patients with STS of the trunk and extremities treated at Memorial Cancer Center from 1935 to 1959, 187 patients (29%) had recurrence.…”

Section: Discussionmentioning

confidence: 99%

Clinical importance of late recurrence in soft-tissue sarcomas

et al. 2000

J. Surg. Oncol.

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“…Inadequate surgery is still frequently performed, however, before proper consultation with specialist centres, resulting in a high incidence of local recurrence, which has long been considered to be an ominous prognostic sign. 5,[10][11][12][13] Several recent reports, however, have suggested that local recurrence does not adversely affect survival, [14][15][16][17][18][19] but Pisters et al 30 have recently indicated that patients with locally recurrent disease when first seen are at increased risk of subsequent local recurrence and of death from the disease. As Evans 9 has pointed out, there are two patterns of local recurrence: first, that following a limited operation with an inadequate surgical margin, so-called 'local persistence', and secondly local recurrence after radical surgery with an adequate surgical margin.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Even after a radical operation, there is local recurrence in about 5% to 10% of patients, although the impact of this on survival remains uncertain. 8,9 Some previous reports 5, [10][11][12][13] indicate that this is a grave prognostic sign, but others disagree. [14][15][16][17][18][19] Evans 9 has recently suggested the importance of distinguishing two manifestations of locally recurrent disease stating that "Local recurrence following radical surgery is a grave sign, but local recurrence following limited surgery, which is labelled 'local persistence' is often an innocent event".…”

mentioning

confidence: 96%

Influence of Local Recurrence on the Prognosis of Soft-Tissue Sarcomas

Ueda¹,

Yoshikawa²,

Mori³

et al. 1997

The Journal of Bone and Joint Surgery. British volume

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We have investigated the significance of local recurrence on survival in 173 patients with localised soft-tissue sarcomas of the limbs and of the trunk.The overall survival rates at five and ten years were 75.2% and 68.0%, respectively. After definitive surgery at our hospitals, there was local recurrence in 25 patients (14.5%). After inadequate operations elsewhere, there was a higher incidence of late local recurrence (28.3%), in comparison with those with primary tumours treated by us (9.0%), or patients referred to us immediately after inadequate surgery elsewhere (10.2%). Because of small numbers these differences in the survival rates were not statistically significantly different.Univariate survival analysis showed that local recurrence after definitive surgery (p = 0.006) together with the histological grade (p = 0.0002), the size of the tumour (p = 0.002), its depth in relation to deep fascia (p = 0.003), and the surgical margin (p = 0.0001) were the significant prognostic factors. Local recurrence at the initial presentation did not affect survival. Multivariate analysis showed that local recurrence after definitive surgery also lost its apparent prognostic significance.

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The Problem of Local Recurrence after Treatment of Soft Tissue Sarcoma

Cited by 285 publications

References 8 publications

Usefulness of Argyrophilic Nucleolar Organizer Staining for Predicting Prognosis of Patients with Recurrent Soft Tissue Sarcoma

Usefulness of Argyrophilic Nucleolar Organizer Staining for Predicting Prognosis of Patients with Recurrent Soft Tissue Sarcoma

Clinical importance of late recurrence in soft-tissue sarcomas

Influence of Local Recurrence on the Prognosis of Soft-Tissue Sarcomas

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