Long-term outcome of patients with American Joint Committee on Cancer stage IIB extremity soft tissue sarcomas.
OBJECTIVE
It has been suggested that patients with small (< 5 cm), high-grade extremity soft tissue sarcomas (STS) have an excellent overall prognosis and, consequently, may not require adjuvant therapies.


METHODS
A comprehensive review of all patients with extremity STS treated at a tertiary care cancer hospital over a 9-year period (January 1984 to December 1992) was performed. Prognostic factors, treatment data, and long-term outcome were evaluated in the subset of 111 patients with American Joint Committee on Cancer stage IIB (G3/4, T1a/b) disease.


RESULTS
The median tumor size was 3.0 cm (range, 0.6 to 4.9 cm), and 55 tumors (50%) were deep in location. All patients underwent surgical resection; 68 (61%) received pre- or postoperative radiotherapy, and 32 (29%) received doxorubicin-based chemotherapy. The median follow-up was 76 months. Forty patients (36%) experienced 59 recurrences. First recurrences occurred at local, regional, and distant sites in 21, five, and 14 patients, respectively. The 5-year actuarial local recurrence-free, distant recurrence-free, disease-free, and overall survival rates were 82%, 83%, 68%, and 83%, respectively. The presence of a microscopically positive surgical margin was an independent adverse prognostic factor for both local recurrence (relative risk [RR] = 3.75; 95% confidence interval [CI], 1.25 to 11.25; P =.02) and disease-free survival (RR = 2.57; 95% CI, 1.33 to 4.98; P =.005).


CONCLUSIONS
Event-free outcome for this subset of patients with high-grade STS does not seem as favorable as previously reported by other investigators. Patients who undergo maximal surgical resection with microscopically positive margins represent a subset of T1 STS patients who warrant consideration for adjuvant therapies.
Fleming
J B
JB
Sarcoma Center at The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4195, USA.
Berman
R S
RS
Cheng
S C
SC
Chen
N P
NP
Hunt
K K
KK
Feig
B W
BW
Respondek
P M
PM
Yasko
A W
AW
Pollack
A
A
Patel
S R
SR
Burgess
M A
MA
Papadopoulos
N E
NE
Plager
C
C
Zagars
G
G
Benjamin
R S
RS
Pollock
R E
RE
Pisters
P W
PW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy