title: Factors associated with reduced functional outcome and quality of life in patients having limb-sparing surgery for soft tissue sarcomas - a national multicenter study of 128 patients.
abstract: BACKGROUND
  Limb-sparing surgery for sarcomas has become possible in most cases. However, the impact of the procedure on the functional outcome has only been investigated in a few studies. The aim of this study has been to identify tumor- and patient-related factors associated with reduced functional outcome and quality of life after limb-sparing surgery in soft tissue sarcoma patients.
  
  
  METHODS
  In total, 128 patients (mean age = 58, female/male = 54/74) who were treated with limb-sparing surgery without bone resection for soft tissue sarcomas in Denmark during the period 1 January 2009 to 31 December 2011 were included. Patients were asked to participate at least one year after surgery, and patients who had experienced local recurrence or metastatic disease were excluded. The Toronto Extremity Salvage Score (TESS) measured functional disability, while the Musculoskeletal Tumor Society Score (MSTS) measured functional impairment. European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 measured quality of life. Tumor- and patient-related factors (age, gender, tumor depth, tumor size, malignancy, comorbidity, location, and radiotherapy) were extracted from the Danish National Sarcoma Database. Wilcoxon rank-sum test and Kruskal-Wallis were used for univariable analysis. Adjusted odds ratios were estimated by using multiple logistic regression models.
  
  
  RESULTS
  In the multiple regression analysis, it was found that female gender (p = 0.03), lower extremity tumors (p < 0.01) and radiotherapy (p = 0.02) resulted in an increased risk of a lower TESS score. Initial reduced postoperative function was found to be associated with a lower functional outcome. Patients with reduced functional outcome have increased risk for reduced quality of life (p < 0.01).
  
  
  CONCLUSIONS
  The results of this study show that patient- and tumor-related factors have an important role in the functional outcome.
authors.affiliation: a Department of Experimental Clinical Oncology , Aarhus University Hospital , Aarhus , Denmark.|b Department of Orthopedic Surgery , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Casper
authors.initials: C
authors.lastname: Saebye
authors.affiliation: d Department of Orthopedic Surgery , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Fugloe
authors.affiliation: d Department of Orthopedic Surgery , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Tine
authors.initials: T
authors.lastname: Nymark
authors.affiliation: c Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Akmal
authors.initials: A
authors.lastname: Safwat
authors.affiliation: d Department of Orthopedic Surgery , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Petersen
authors.affiliation: b Department of Orthopedic Surgery , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Baad-Hansen
authors.affiliation: e Department of Oncology , Herlev Hospital , Herlev , Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Krarup-Hansen
authors.affiliation: b Department of Orthopedic Surgery , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Johnny
authors.initials: J
authors.lastname: Keller
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012509:Sarcoma / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*