title: Soft tissue sarcoma of extremities: the prognostic significance of adequate surgical margins in primary operation and reoperation after recurrence.
abstract: BACKGROUND
  Adult soft tissue sarcomas (STS) of extremities are prone to recurrence despite apparently complete resection. This study aimed to explore the impact of clinicopathological factors on outcome and to define an "oncological safe margin" in these patients.
  
  
  METHODS
  A total of 181 patients with extremity STS were enrolled in a retrospective study. The prognostic influence of margin status and other clinicopathological characteristics on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-specific survival (DSS), were examined by univariate and multivariate analyses. The influence of surgical margins on postrecurrence survival (PRS) of patients undergoing reoperation for relapsed lesions during follow-up was analyzed by the Kaplan-Meier method.
  
  
  RESULTS
  Surgical margin width <10 mm and deep tumor depth at primary operation were consistently statistically significant independent adverse factors for LRFS, DMFS, and DSS. Patients with liposarcoma or low grade tumors had significantly higher chances of achieving adequate margins. Of 83 patients who experienced recurrence or metastasis, 53 (63.9%) received reoperation for their relapsed lesions. Patients who achieved microscopically negative margins (R0) at reoperation had significantly better PRS than those who did not (P < 0.007). Overall, patients with no recurrences had the best DSS, while relapsed patients receiving R0 reoperation had better DSS than those receiving either non-R0 reoperation or no reoperation at all.
  
  
  CONCLUSIONS
  Surgical margins prognostically influence survival in both patients undergoing primary surgery and those undergoing reoperation for relapse of extremity STS. In primary surgery, the chance of achieving adequate margin may reflect the underlying aggressiveness of tumors.
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Liu
authors.forename: Chueh-Chuan
authors.initials: CC
authors.lastname: Yen
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Chen
authors.forename: Tain-Hsiung
authors.initials: TH
authors.lastname: Chen
authors.forename: Paul Chih-Hsueh
authors.initials: PC
authors.lastname: Chen
authors.forename: Hung-Ta Hondar
authors.initials: HT
authors.lastname: Wu
authors.forename: Cheng-Ying
authors.initials: CY
authors.lastname: Shiau
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Wu
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Liu
authors.forename: Cheng-Hwai
authors.initials: CH
authors.lastname: Tzeng
mesh_terms: D000704:Analysis of Variance; D018572:Disease-Free Survival; D005121:Extremities / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome