title: Surgery quality and tumor status impact on survival and local control of resectable liposarcomas of extremities or the trunk wall.
abstract: BACKGROUND
  The 5-year survival rates for localized liposarcomas reportedly vary from 75% to 91% with histologic grade as the most important prognostic factor. However, it is unclear which other factors, including the initial surgery quality and recurrent tumors, influence survival in localized liposarcomas (LPS).
  
  
  OBJECTIVE
  We analyzed factors (including AJCC staging system) influencing survival and local control of resectable LPS of the extremities/trunk wall and the impact of surgery quality and tumor status and type of disease recurrences according to pathological subtype.
  
  
  METHODS
  We retrospectively reviewed 181 patients with localized LPS: 110 were treated for primary tumors, 50 for recurrent tumors, and 21 for wide scar resection after unplanned nonradical resection. We determined survival rates and examined factors influencing survival. The minimum followup was 4 months (median, 52 months; range, 4-168 months).
  
  
  RESULTS
  Five-year disease-specific (DSS), disease-free (DFS), and local relapse-free survival (LRFS) rates were: 80%, 58%, and 75%, respectively. Five-year local relapse-free survival rates for primary versus clinically recurrent tumor versus scar after nonradical resection were: 86.1%, 52.1%, and 73.3%, respectively. The following were independent negative prognostic factors for DSS (AJCC Stage ≥ IIb), DFS (Grade 3; clinical recurrence; skin infiltration), and LRFS (clinical recurrence; R1 resection). An unplanned excision, although influencing local relapse-free survival, had no impact on disease-specific survival (calculated from date of first excision 5-year rate of 80%, considering impact of combined treatment of clinical recurrence/scar).
  
  
  CONCLUSIONS
  We confirmed the value of AJCC staging for predicting disease-specific survival in extremity/trunk wall LPS. Radical reresection of scar after nonradical primary tumor resection (+ radiotherapy) seems to improve disease-free and local relapse-free survival in liposarcomas. Patients with unplanned excision can be cured when referred to a sarcoma unit.
  
  
  METHODS
  Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland. rutkowskip@coi.waw.pl
authors.forename: Piotr
authors.initials: P
authors.lastname: Rutkowski
authors.forename: Sławomir
authors.initials: S
authors.lastname: Trepka
authors.forename: Konrad
authors.initials: K
authors.lastname: Ptaszynski
authors.forename: Milena
authors.initials: M
authors.lastname: Kołodziejczyk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005121:Extremities; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008080:Liposarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013997:Time Factors; D060726:Torso; D016896:Treatment Outcome; D055815:Young Adult