title: Bone invasion in extremity soft-tissue sarcoma: impact on disease outcomes.
abstract: BACKGROUND
  The purpose of the current study was to evaluate histologic bone invasion as a predictor of oncologic outcome in extremity soft-tissue sarcoma (STS) patients presenting to a specialty sarcoma center between 1986 and 2001.
  
  
  METHODS
  All patients who underwent surgery for extremity STS were identified from the prospective database at the study institution. Patient demographic features were compared using chi-square analyses or independent-sample Student t-tests. The disease outcomes were compared for those with and without bone invasion using Kaplan-Meier survival analysis and Cox modeling.
  
  
  RESULTS
  In a review of 874 patients with STS of the extremity, 48 patients (5.5%) had evidence of bone invasion. Patients with bone invasion presented with larger tumors that were more frequently deep in the extremity and more often had metastases at presentation. Patients with bone invasion had lower metastasis-free survival but bone invasion was not found to be an independent prognostic factor (P = .274) on Cox modeling. Bone invasion was found to be prognostic of overall survival on multivariate analysis (P < .0001).
  
  
  CONCLUSIONS
  In a small percentage of patients with STS, bone resection may be required to obtain an adequate surgical margin, thereby limiting the risk of local tumor recurrence. Histologic bone invasion portends a poorer prognosis in terms of overall survival.
authors.affiliation: University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada. pferguson@mtsinai.on.ca
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ferguson
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Griffin
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.forename: Ally
authors.initials: A
authors.lastname: Murji
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bell
authors.forename: Jay S
authors.initials: JS
authors.lastname: Wunder
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery; D001842:Bone and Bones / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000601:surgery; D018365:Neoplasm, Residual; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012509:Sarcoma / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis