High-grade soft tissue sarcomas of the extremities: surgical margins influence only local recurrence not overall survival.
OBJECTIVE
After surgical treatment of high-grade soft tissue sarcomas, local recurrences, metastases and survival remain a great concern. Further knowledge on factors with a possible impact on these endpoints, specifically resection margins, is relevant for decision-making regarding the aggressiveness of local treatment. The aim of this study is to investigate the impact of prognostic factors on local recurrence and overall survival for patients with high-grade soft tissue sarcomas of the extremities.


METHODS
In a retrospective cohort study of 127 patients (mean age 48 years, range five to 91; median follow-up 71 months) the prognostic effect of margin status and other clinicopathologic characteristics on local recurrence and overall survival were analysed by employing a multivariate Cox regression.


RESULTS
Five-year cumulative incidence of local recurrence and distant metastases was 26% and 40%, respectively. The estimated five-year overall survival was 59%. Tumour size proved a consistent adverse prognostic factor for local recurrence (hazard ratio (HR) 3.9), distant metastasis (HR 4.9) and overall survival (HR 2.4). The significant association of resection margins with local recurrence (HR 10.2) was confirmed. Margins were however not significantly associated with the occurrence of distant metastasis or overall survival. The occurrence of local recurrence had a significant impact on overall survival (HR 2.0).


CONCLUSIONS
The results of this study confirm the critical role of tumour size on survival and margins on local recurrence, and stress the need for further investigation concerning the association between margins, local recurrence and survival.
Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands, j.j.willeumier@lumc.nl.
Julie
J
Willeumier
Marta
M
Fiocco
Remi
R
Nout
Sander
S
Dijkstra
William
W
Aston
Rob
R
Pollock
Henk
H
Hartgrink
Judith
J
Bovée
Michiel
M
van de Sande
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005121:Extremities / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D055815:Young Adult