title: Impact of margin status and local recurrence on soft-tissue sarcoma outcomes.
abstract: BACKGROUND
  The impact of local recurrence and surgical resection margin status on survival in extremity soft-tissue sarcomas remains to be clearly defined. Our aim was to conduct a retrospective analysis of prospectively collected data to determine the prognostic relevance of positive resection margins and local recurrence for extremity soft-tissue sarcomas for survival.
  
  
  METHODS
  Three hundred and sixty-three patients who underwent resection of localized primary extremity soft-tissue sarcomas with curative intent were selected from the United States Department of Defense Automated Central Tumor Registry. Outcomes for local recurrence, distant recurrence, disease-specific survival, and overall survival were analyzed according to clinical, pathological, and treatment variables with use of the Kaplan-Meier method (log-rank test) and the multivariate Cox regression model.
  
  
  RESULTS
  Positive margins (hazard ratio, 1.99 [95% confidence interval, 1.15 to 3.45]), local recurrence (hazard ratio, 2.93 [95% confidence interval, 1.38 to 6.23]), and distant recurrence (hazard ratio, 12.13 [95% confidence interval, 5.97 to 24.65]) were significantly associated with overall survival on multivariate Cox regression analysis. However, for disease-specific survival, local recurrence was not significant and tumor size of >10 cm (hazard ratio, 2.83 [95% confidence interval, 1.15 to 6.95]), positive margins (hazard ratio, 1.95 [95% confidence interval, 1.05 to 3.63]), and distant recurrence (hazard ratio, 9.46 [95% confidence interval, 4.37 to 20.47]) were independent adverse prognostic factors. The disease-specific survival rate for patients with localized soft-tissue sarcomas was 89% (95% confidence interval, 85% to 92%) for five years and 75% (95% confidence interval, 70% to 81%) for ten years.
  
  
  CONCLUSIONS
  Positive surgical margins are consistently associated with adverse survival-related outcomes in localized soft-tissue sarcomas of the extremity. Local recurrence had a significant impact on overall survival, but not on disease-specific survival.
authors.affiliation: Departments of Orthopaedics (B.K.P., C.B.H., and J.A.F) and Surgery (P.F.H. and J.C.G.), Walter Reed National Military Medical Center, 8901 Rockville Pike, America Building (Building 19), 2nd Floor, Orthopaedics, Bethesda, MD 20889. E-mail address for B.K. Potter: Benjamin.K.Potter.mil@health.mil.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
authors.forename: Paul F
authors.initials: PF
authors.lastname: Hwang
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forsberg
authors.forename: Chadwick B
authors.initials: CB
authors.lastname: Hampton
authors.forename: John C
authors.initials: JC
authors.lastname: Graybill
authors.forename: George E
authors.initials: GE
authors.lastname: Peoples
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome