title: Tumor rupture predicts early metastasis and poor prognosis in stage III soft tissue sarcomas.
abstract: BACKGROUND
  Tumor rupture is considered a R2 resection and is not uncommonly encountered when attempting a tumor-free resection, especially in high-risk soft tissue sarcomas. The predictive value of tumor rupture for metastasis development and its impact on metastasis-free interval needs to be investigated and further taken into consideration in preoperative planning.
  
  
  METHODS
  From January 1993 to December 2009, 276 cases of stage III soft tissue sarcoma were collected from Tianjin Medical University Cancer Institution and Hospital. The clinical characteristics and histopathological features were retrospectively reviewed and analyzed with treatment modalities, tumor rupture status for disease-specific survival (DSS), distant recurrence-free survival (DRFS), and metastasis-free interval (MFI).
  
  
  RESULTS
  Of the 276 patients who underwent surgical resection of their tumors, 53 patients experienced a tumor rupture. Median follow-up period was 68 months. Two-year and 5-year overall survival rates for patients with tumor rupture were 46 and 27% compared with 76 and 57% for patients without tumor rupture, respectively. Median overall survival for patients with tumor rupture was 24 months compared with 56 months for those without. In multivariate analysis, FNCLCC grade III, tumor>10 cm, tumor rupture, and no chemotherapy were associated with decreased DSS and DRFS. Tumor rupture predicted shorter MFI of 5 months compared with 15 months of those without tumor rupture.
  
  
  CONCLUSIONS
  Tumor rupture was associated with decreased DSS and DRFS in stage III sarcomas. It also predicted early metastasis and directly impacted patient's survival. Additional procedures should be investigated to avoid tumor rupture.
authors.affiliation: Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi road, Hexi district, Tianjin, 300060, China. chenyong780417@gmail.com
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.forename: JiHui
authors.initials: J
authors.lastname: Hao
authors.forename: Yun
authors.initials: Y
authors.lastname: Yang
authors.forename: JiLong
authors.initials: J
authors.lastname: Yang
authors.forename: XiShan
authors.initials: X
authors.lastname: Hao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D055815:Young Adult