title: Prognostic value of necrosis after neoadjuvant therapy for soft tissue sarcoma.
abstract: OBJECTIVE
  While treatment-induced tissue necrosis is a well-documented predictor of patient survival in malignant bone tumors, its prognostic value in soft tissue sarcomas is controversial. A prior study from our institution did not find a prognostic value to tumor necrosis. We analyze a more extensive database of high-grade soft tissue sarcomas treated with neoadjuvant chemotherapy, radiation therapy, or both to re-evaluate if the degree of tumor necrosis alone can be used as a predictive factor for local recurrence, metastasis, and disease-specific survival.
  
  
  METHODS
  Two hundred and seven patients with high-grade extremity soft tissue sarcoma received neoadjuvant chemotherapy and/or radiation therapy and wide excision. Tumor treatment response was determined by histopathologic analysis, and patients were followed for local recurrence, metastasis, or death.
  
  
  RESULTS
  Tumor necrosis ≥ 90% correlates with improved disease-free survival with univariate analysis, but this does not reach statistical significance on multivariate analysis. Age and tumor volume were found to be the only independent predictors of disease-free survival on multivariate analysis.
  
  
  CONCLUSIONS
  There is insufficient evidence to support the use of necrosis to prognosticate survival and alter chemoradiation regimens in high grade soft tissue sarcomas of the extremity. Larger studies are needed to definitively address the prognostic value of necrosis.
  
  
  METHODS
  Level II, Prognostic
authors.affiliation: Department of Orthopaedic Surgery, Los Angeles County - University of Southern California Medical Center, Keck School of Medicine, Los Angeles, California.
authors.forename: Max
authors.initials: M
authors.lastname: Vaynrub
authors.forename: Nima
authors.initials: N
authors.lastname: Taheri
authors.forename: Elke R
authors.initials: ER
authors.lastname: Ahlmann
authors.forename: Caroline
authors.initials: C
authors.lastname: Yao
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Fedenko
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Allison
authors.forename: Sant P
authors.initials: SP
authors.lastname: Chawla
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Menendez
mesh_terms: D000367:Age Factors; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy
keywords: chemotherapy; metastasis; predictive; radiation therapy; recurrence; survival