title: Managing soft tissue sarcomas in a developing country: are prognostic factors similar to those of developed world?
abstract: BACKGROUND
  Managing soft tissue sarcomas (STS) in a developing country with limited financial resources and a poor health referral system is a challenge. Presenting late, these extremity STS are prone to recurrence despite apparently complete resection. This study aimed to explore and compare the impact of clinico-pathological factors on recurrence and survival in Pakistan with the corresponding figures quoted from the developed world.
  
  
  METHODS
  An institutional review was performed on all patients with primary STS of the extremities operated on between 1994 and 2008. The prognostic influence of clinical, pathologic, and treatment variables on local recurrence free survival (LRFS), metastasis free survival (MFS) and overall survival (OS) were analyzed by univariate and multivariate Cox regression analysis and Kaplan Meier survival curves.
  
  
  RESULTS
  A total of 84 patients with a mean age of 41.8 ± 21.9 years were included in the study. The local recurrence rate was 14.3% after a median of 6 (mean 7.4) months. Metastases occurred in 7 patients (8.3%) and 65 patients were alive without evidence of disease after a mean follow-up of 52.6 ± 39.8 months. Tumor size > 5 cm, grade 3 tumors and margin < 10 mm significantly increased local recurrence rates. A margin ≥ 10 mm and age < 45 years significantly enhanced cumulative survival. Significant multivariate risk factors for metastases were margin < 10 mm and tumor grade G3.
  
  
  CONCLUSIONS
  Despite a poor health referral system in our country, our results are no different from those reported from the developed world. Surgical margins and tumor grade prognostically influenced LRFS, MFS and OS.
authors.affiliation: Orthopaedic Surgery Department, Aga Khan University Hospital, Karachi 74800, Pakistan.
authors.forename: Irfan
authors.initials: I
authors.lastname: Qadir
authors.forename: Masood
authors.initials: M
authors.lastname: Umer
authors.forename: Hafiz Muhammad
authors.initials: HM
authors.lastname: Umer
authors.forename: Nasir
authors.initials: N
authors.lastname: Uddin
authors.forename: Farrok
authors.initials: F
authors.lastname: Karsan
authors.forename: Muhammad Sharoz
authors.initials: MS
authors.lastname: Rabbani
mesh_terms: D000328:Adult; D000368:Aged; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology / Q000556:secondary / Q000601:surgery