title: What are risk factors for local recurrence of deep high-grade soft-tissue sarcomas?
abstract: BACKGROUND
  Patients with local recurrence of soft-tissue sarcomas have a poor overall survival. High-grade, soft-tissue sarcomas in deep locations may have a poorer prognosis regarding local recurrence than low-grade sarcomas or those located superficially. Although previous reports evaluated tumors at various depths, it is unclear what factors influence recurrence of deep, high-grade sarcomas.
  
  
  OBJECTIVE
  We therefore determined whether possible risk factors (tumor size, location, histologic subtype, unplanned excision, local recurrence at presentation, metastasis at diagnosis, surgical procedure, surgical margin, and adjuvant treatments) influenced local recurrence of deep, high-grade, soft-tissue sarcomas.
  
  
  METHODS
  We retrospectively reviewed 433 patients with deep, high-grade, soft-tissue sarcomas surgically treated between 1985 and 2005. For each patient, we reviewed tumor size, location, histologic subtype, unplanned excision, local recurrence at presentation, metastasis at diagnosis, surgical procedure, surgical margin, and adjuvant treatments and determined the effect of each prognostic variable on local recurrence. The minimum followup was 1 month (median, 51 months; range, 1-305 months).
  
  
  RESULTS
  Forty-seven patients had local recurrence at a median of 10.7 months. Local recurrence at presentation, metastasis at diagnosis, and positive margins independently predicted local recurrence. No other factors independently predicted local recurrence.
  
  
  CONCLUSIONS
  Unplanned excisions did not increase the rate of local recurrence of deep, high-grade, soft-tissue sarcomas if treated appropriately. Aggressiveness of tumor represented by metastasis or local recurrence at presentation may be a risk for local recurrence.
  
  
  METHODS
  Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Cancer Institute Hospital for Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, 135-8550 Tokyo, Japan. sawaorth@tmd.ac.jp
authors.forename: Chigusa
authors.initials: C
authors.lastname: Sawamura
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimoji
authors.forename: Taisuke
authors.initials: T
authors.lastname: Tanizawa
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ae
mesh_terms: D005260:Female; D051677:Histiocytoma, Malignant Fibrous / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery