title: Prognostic factors and outcome of spermatic cord sarcoma.
abstract: OBJECTIVE
  To evaluate management and outcome in a large series of patients with spermatic cord sarcomas (SCS), a rare malignancy.
  
  
  METHODS
  Eighty-two patients with localized SCS treated at two dedicated sarcoma units between 1992 and 2013 were included. Disease-specific survival (DSS) and crude cumulative incidence of local recurrence and distant metastases (DM) were estimated by Kaplan-Meier plots and log rank tests.
  
  
  RESULTS
  Median follow-up was 33 months (interquartile range 13-72 months). Sixty-one patients presented with primary disease. Liposarcoma was the most common histotype, but surprisingly, 37 % of tumors were of high grade. Seventeen patients (21 %) received radiotherapy and 12 patients (15 %) chemotherapy. Five-year DSS for the whole series was 92 % [95 % confidence interval (CI) 83-97]. Five-year rates of local recurrence and DM were 26 % (95 % CI 15-42) and 24 % (95 % CI 15-38), respectively. Tumor grade was found to be a significant predictor of both DSS and DM (both p < 0.001). Quality of surgical margins was proved to affect the local outcome (p = 0.025), while the rates of distant metastases were found to differ significantly by histology (p = 0.010). Exclusively in the liposarcoma subgroup, quality of surgical margins was also directly associated with DSS (p = 0.043).
  
  
  CONCLUSIONS
  Wide excision of the tumor is critical for cure, especially in the liposarcoma subgroup. The role of radiotherapy and chemotherapy is not established.
authors.affiliation: Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Radaelli
authors.forename: Anant
authors.initials: A
authors.lastname: Desai
authors.forename: James
authors.initials: J
authors.lastname: Hodson
authors.forename: Chiara
authors.initials: C
authors.lastname: Colombo
authors.forename: Keith
authors.initials: K
authors.lastname: Roberts
authors.forename: David
authors.initials: D
authors.lastname: Gourevitch
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gronchi
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D005832:Genital Diseases, Male / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008080:Liposarcoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D013085:Spermatic Cord / Q000473:pathology*; D015996:Survival Rate