Tumor-skin invasion is a reliable risk factor for poor prognosis in superficial soft tissue sarcomas

Abstract

Introduction Superficial soft tissue sarcomas are often left untreated unless they invade the skin and skin ulcers manifest. Progressive sarcomas frequently result in dismal oncological outcomes despite multidisciplinary treatment. This study aimed to identify prognostic factors for superficial soft tissue sarcomas. Materials and methods This study retrospectively analyzed the clinicopathological data of 82 patients with superficial soft tissue sarcomas treated between August 2003 and December 2020 at our institution. A superficial soft tissue sarcoma was defined if the percentage of the area occupied by the tumor in the assessed region (skin, subcutaneous) was more than 50%. Age, sex, location, tumor size, tumor-skin invasion, tumor grade, and distant metastasis at initial diagnosis were evaluated as potential prognostic factors. Cox proportional hazards regression models were used to identify the prognostic factors. Five-year survival rates were assessed by the Kaplan-Meier method. Results The mean follow-up time was 60.1 months. The 5-year overall survival, 5-year local recurrence-free survival, and 5-year metastasis survival rates were 76.4%, 60.6%, and 71.0%, respectively. Univariate analysis showed significant relationships between poor prognosis and tumor size ≥5 cm, distant metastasis at initial diagnosis, and tumor-skin invasion. In the multivariate analysis, only the tumor-skin invasion was associated with worse overall survival. Conclusions Superficial soft tissue sarcomas have biologically been considered a separate category due to their better prognosis. In this study, the tumor-skin invasion was the only significant factor associated with a poor prognosis. Therefore, all superficial soft tissue sarcomas without tumor-skin invasion should be treated as early as possible.

Challenges in the Management of Complex Soft-Tissue Sarcoma Clinical Scenarios

“…Studies have shown higher rates of metastasis at presentation, increased rates of amputation, and higher rates of local recurrence in fungating groups when compared with their nonfungating tumor control groups. [27][28][29] Similarly, 5-year overall survival for patients with a fungating sarcoma is as low as 15.5% compared with 65.6% for nonfungating tumors. 28 Tumor ulceration and invasion of the skin is associated with worse overall survival, which further underpins the importance of prevention and early identification.…”

“…28 Tumor ulceration and invasion of the skin is associated with worse overall survival, which further underpins the importance of prevention and early identification. 29 In general, outcomes and prognosis after amputation of STS fungating masses are modest, with a poor overall survival. Palliative amputation decreases pain scores, improves mobility after amputation, and improves emotional and psychological well-being.…”

“…28 Tumor ulceration and invasion of the skin is associated with worse overall survival, which further underpins the importance of prevention and early identification. 29…”