'Beware the lump in the foot!': predictors of recurrence and survival in bone and soft-tissue sarcomas of the foot and ankle.
BACKGROUND
Although benign lumps around the foot and ankle are common, sarcomas in this area are frequently missed, and the consequences can be disastrous. Patients are often referred to tumour centres after suboptimal prior surgical excision. The predictors of local recurrence, metastasis and survival in this cohort have yet to be elucidated.


METHODS
We performed a retrospective review of 61 consecutive patients that were surgically treated for a bone (BS) or soft-tissue sarcoma (STS) of the foot and ankle between 1996 and 2012 at a specialist tumour centre. Factors such as tumour versus non-tumour centre surgery and BS versus STS were examined. Univariate and multivariate analyses were performed to determine which factors predicted local recurrence, metastasis and survival.


RESULTS
The overall 5-year survival rates were 74% in the STS group and 90% in the BS group. Furthermore, 33 (54%) patients had STS. Non-tumour centre surgery was performed in 23 (38%) patients. Overall local recurrence rate was 6.6%. Intra-lesional margins predicted a local recurrence, whereas non-tumour centre surgery was a predictor for developing a metastasis post-treatment. Tumour size, STS, radical margins (i.e. entire anatomical compartment removed with tumour) and metastasis, either at the time of referral or post-treatment, were associated with higher mortality.


CONCLUSIONS
STSs of the foot and ankle appear to have a worse prognosis than BSs. Early referral to a specialist tumour centre before surgical intervention is recommended.
Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Andrew
A
Salipas
Michelle M
MM
Dowsey
Deborah
D
May
Peter F M
PF
Choong
D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005528:Foot; D005529:Foot Bones; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate
ankle; foot; local recurrence; metastasis; sarcoma; surgery