Bone invasion in extremity soft-tissue sarcoma: impact on disease outcomes.
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.
Ferguson
Peter C
PC
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada. pferguson@mtsinai.on.ca
Griffin
Anthony M
AM
O'Sullivan
Brian
B
Catton
Charles N
CN
Davis
Aileen M
AM
Murji
Ally
A
Bell
Robert S
RS
Wunder
Jay S
JS
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