title: Long-term outcome of patients with American Joint Committee on Cancer stage IIB extremity soft tissue sarcomas.
abstract: 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.
authors.affiliation: Sarcoma Center at The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4195, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Fleming
authors.forename: R S
authors.initials: RS
authors.lastname: Berman
authors.forename: S C
authors.initials: SC
authors.lastname: Cheng
authors.forename: N P
authors.initials: NP
authors.lastname: Chen
authors.forename: K K
authors.initials: KK
authors.lastname: Hunt
authors.forename: B W
authors.initials: BW
authors.lastname: Feig
authors.forename: P M
authors.initials: PM
authors.lastname: Respondek
authors.forename: A W
authors.initials: AW
authors.lastname: Yasko
authors.forename: A
authors.initials: A
authors.lastname: Pollack
authors.forename: S R
authors.initials: SR
authors.lastname: Patel
authors.forename: M A
authors.initials: MA
authors.lastname: Burgess
authors.forename: N E
authors.initials: NE
authors.lastname: Papadopoulos
authors.forename: C
authors.initials: C
authors.lastname: Plager
authors.forename: G
authors.initials: G
authors.lastname: Zagars
authors.forename: R S
authors.initials: RS
authors.lastname: Benjamin
authors.forename: R E
authors.initials: RE
authors.lastname: Pollock
authors.forename: P W
authors.initials: PW
authors.lastname: Pisters
mesh_terms: 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