title: Extremity soft tissue sarcoma: adding to the prognostic meaning of local failure.
abstract: BACKGROUND
  We explored the prognostic meaning of local relapse and surgical margins in adult soft tissue sarcoma of the extremities.
  
  
  METHODS
  Out of a series of 1017 patients with extremity soft tissue sarcoma treated over 20 years, we picked a group of 238 patients operated on at our institution for their first local relapse: 88 after their primary operation performed at the same center and 150 elsewhere. At operation for relapse, margins were microscopically negative in 77% and 75% of patients, respectively. Median follow-up was 107 months.
  
  
  RESULTS
  The 10-year mortality rate was 22% in the absence of local relapse, whereas in locally relapsing patients it was 54% and 43%, respectively, for patients first operated on at our institute and for those who were not. The hazard ratio of positive versus negative surgical margins was 1.7 for cause-specific death and 2.1 for distant metastases in patients first operated on at our institute, as opposed to 1.2 and 1.3 for the others.
  
  
  CONCLUSIONS
  Local relapse was an unfavorable prognostic factor. In the face of a consistent surgical policy for local relapse in a single-institution setting, patients relapsing after the first operation performed at our institution received rescue treatment less frequently than those previously operated on outside a referral center. This is likely due to an inherently higher tumor aggressiveness. In the presence of such a higher aggressiveness, the adequacy of surgical margins at operation for first relapse seemed more critical prognostically. This may have clinical and speculative implications.
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: Alessandro
authors.initials: A
authors.lastname: Gronchi
authors.forename: Rosalba
authors.initials: R
authors.lastname: Miceli
authors.forename: Marco
authors.initials: M
authors.lastname: Fiore
authors.forename: Paola
authors.initials: P
authors.lastname: Collini
authors.forename: Laura
authors.initials: L
authors.lastname: Lozza
authors.forename: Federica
authors.initials: F
authors.lastname: Grosso
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Casali
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D012509:Sarcoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D017211:Treatment Failure; D034941:Upper Extremity / Q000473:pathology