title: Association of local recurrence with subsequent survival in extremity soft tissue sarcoma.
abstract: OBJECTIVE
  The aim of this study was to analyze local recurrence in a large cohort of prospectively followed patients with primary extremity soft tissue sarcoma. In particular, we analyzed the correlation of local recurrence with subsequent metastasis and disease-specific survival.
  
  
  METHODS
  Patients who underwent treatment for primary extremity soft tissue sarcoma from July 1982 through July 1995 at Memorial Sloan-Kettering Cancer Center were the subject of this study. Local recurrence, distant metastasis, and disease-specific survival were used as end points of the study. The influence of local recurrence on subsequent distant metastasis and disease-specific survival were examined using the Cox proportional hazards model.
  
  
  RESULTS
  We treated 911 patients, of whom 297 (33%) developed recurrent disease. Local recurrence occurred in 116 patients (13%), metastasis in 167 (18%), and synchronous local recurrence and metastasis in 13 (2%). Of 116 patients who developed local recurrence, 38 subsequently developed metastasis and 34 died of disease. Metastasis after local recurrence was predicted in patients with initial high-grade (P = .005; risk = 3.5) or deep (P = .02; risk = 2.9) tumors. Tumor mortality after local recurrence was predicted in patients with initial high-grade (P = .007; risk = 3.7) or large (> 5 cm; P = .01; risk = 3.2) primary tumors.
  
  
  CONCLUSIONS
  These findings suggest that there is a strong association of local recurrence with the development of subsequent metastasis and tumor mortality, and that local recurrence is a poor prognostic factor. It would seem prudent to consider patients who develop local recurrence and have high-grade tumors as being at high risk for systemic disease and therefore eligible for investigational adjuvant systemic therapy.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Lewis
authors.forename: D
authors.initials: D
authors.lastname: Leung
authors.forename: M
authors.initials: M
authors.lastname: Heslin
authors.forename: J M
authors.initials: JM
authors.lastname: Woodruff
authors.forename: M F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D001132:Arm; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology* / Q000556:secondary; D012983:Soft Tissue Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000556:secondary