title: Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution.
abstract: OBJECTIVE
  To explore the prognostic effect of microscopic marginal status after surgery for extremity soft tissue sarcomas.
  
  
  METHODS
  We analyzed 911 consecutive patients surgically treated throughout a 20-year span at a single referral center. Six hundred forty-two were first seen with a primary tumor, and 269, with a locally recurrent tumor. All patients underwent macroscopically complete resection. Microscopic marginal status was negative (tumor size > 1 mm) in 748 patients and positive (</= 1 mm) in 163 patients. Median follow-up was 107 months.
  
  
  RESULTS
  Patients with primary disease had a lower disease-specific mortality in comparison to those first examined for recurrence (25% v 37%, respectively, at 10 years). Size, malignancy grade, depth, histotype, and local recurrence had a statistically significant prognostic effect at multivariable analysis, while microscopically positive surgical margins had not, though a trend in favor of negative margins was observed. However, an extra risk was observed for patients with positive margins after 3 to 5 years (hazard ratio, 1.8 after 5 years v 0.8 before 5 years). In patients treated for a local recurrence, the prognostic impact of positive margins was higher (hazard ratio, 1.6).
  
  
  CONCLUSIONS
  Positive surgical margins had a weak adverse prognostic effect, which was more pronounced for those patients escaping an early relapse. This would seem to justify a policy of surgical adequacy in adult soft tissue sarcomas, though clinical decision making in borderline presentations for conservative surgery might be reasonably flexible and shared with the patient. Once a local relapse has occurred, the impact of local treatments seems more critical.
authors.affiliation: Department of Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori, via Venezian,1 - 20133 Milano, Italy. alessandro.gronchi@istitutotumori.mi.it
authors.forename: A
authors.initials: A
authors.lastname: Gronchi
authors.forename: P G
authors.initials: PG
authors.lastname: Casali
authors.forename: L
authors.initials: L
authors.lastname: Mariani
authors.forename: R
authors.initials: R
authors.lastname: Miceli
authors.forename: M
authors.initials: M
authors.lastname: Fiore
authors.forename: S
authors.initials: S
authors.lastname: Lo Vullo
authors.forename: R
authors.initials: R
authors.lastname: Bertulli
authors.forename: P
authors.initials: P
authors.lastname: Collini
authors.forename: L
authors.initials: L
authors.lastname: Lozza
authors.forename: P
authors.initials: P
authors.lastname: Olmi
authors.forename: J
authors.initials: J
authors.lastname: Rosai
mesh_terms: D000328:Adult; D001132:Arm; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012509:Sarcoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*