Extremity soft tissue sarcoma: Adding to the prognostic meaning of local failure

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Abstract

Background: We explored the prognostic meaning of local relapse and surgical margins in adult soft tissue sarcoma of the extremities. Methods: Out of a series of 1017 patients with extremity soft tissue sarcoma treated over 20 years, we picked a group of 238 patients operated on at our institution for their first local relapse: 88 after their primary operation performed at the same center and 150 elsewhere. At operation for relapse, margins were microscopically negative in 77% and 75% of patients, respectively. Median follow-up was 107 months. Results: The 10-year mortality rate was 22% in the absence of local relapse, whereas in locally relapsing patients it was 54% and 43%, respectively, for patients first operated on at our institute and for those who were not. The hazard ratio of positive versus negative surgical margins was 1.7 for cause-specific death and 2.1 for distant metastases in patients first operated on at our institute, as opposed to 1.2 and 1.3 for the others. Conclusions: Local relapse was an unfavorable prognostic factor. In the face of a consistent surgical policy for local relapse in a single-institution setting, patients relapsing after the first operation performed at our institution received rescue treatment less frequently than those previously operated on outside a referral center. This is likely due to an inherently higher tumor aggressiveness. In the presence of such a higher aggressiveness, the adequacy of surgical margins at operation for first relapse seemed more critical prognostically. This may have clinical and speculative implications.

Original languageEnglish
Pages (from-to)1583-1590
Number of pages8
JournalAnnals of Surgical Oncology
Volume14
Issue number5
DOIs
Publication statusPublished - May 2007

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Sarcoma
Extremities
Recurrence
Cause of Death
Referral and Consultation
Neoplasm Metastasis
Mortality
Margins of Excision
Neoplasms

Keywords

  • Limbs
  • Local recurrence
  • Prognosis
  • Sarcoma
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{59507c55e1034f4895ff5cb94ac77699,
title = "Extremity soft tissue sarcoma: Adding to the prognostic meaning of local failure",
abstract = "Background: We explored the prognostic meaning of local relapse and surgical margins in adult soft tissue sarcoma of the extremities. Methods: Out of a series of 1017 patients with extremity soft tissue sarcoma treated over 20 years, we picked a group of 238 patients operated on at our institution for their first local relapse: 88 after their primary operation performed at the same center and 150 elsewhere. At operation for relapse, margins were microscopically negative in 77{\%} and 75{\%} of patients, respectively. Median follow-up was 107 months. Results: The 10-year mortality rate was 22{\%} in the absence of local relapse, whereas in locally relapsing patients it was 54{\%} and 43{\%}, respectively, for patients first operated on at our institute and for those who were not. The hazard ratio of positive versus negative surgical margins was 1.7 for cause-specific death and 2.1 for distant metastases in patients first operated on at our institute, as opposed to 1.2 and 1.3 for the others. Conclusions: Local relapse was an unfavorable prognostic factor. In the face of a consistent surgical policy for local relapse in a single-institution setting, patients relapsing after the first operation performed at our institution received rescue treatment less frequently than those previously operated on outside a referral center. This is likely due to an inherently higher tumor aggressiveness. In the presence of such a higher aggressiveness, the adequacy of surgical margins at operation for first relapse seemed more critical prognostically. This may have clinical and speculative implications.",
keywords = "Limbs, Local recurrence, Prognosis, Sarcoma, Surgery",
author = "Alessandro Gronchi and Rosalba Miceli and Marco Fiore and Paola Collini and Laura Lozza and Federica Grosso and Luigi Mariani and Casali, {Paolo G.}",
year = "2007",
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TY - JOUR

T1 - Extremity soft tissue sarcoma

T2 - Adding to the prognostic meaning of local failure

AU - Gronchi, Alessandro

AU - Miceli, Rosalba

AU - Fiore, Marco

AU - Collini, Paola

AU - Lozza, Laura

AU - Grosso, Federica

AU - Mariani, Luigi

AU - Casali, Paolo G.

PY - 2007/5

Y1 - 2007/5

N2 - Background: We explored the prognostic meaning of local relapse and surgical margins in adult soft tissue sarcoma of the extremities. Methods: Out of a series of 1017 patients with extremity soft tissue sarcoma treated over 20 years, we picked a group of 238 patients operated on at our institution for their first local relapse: 88 after their primary operation performed at the same center and 150 elsewhere. At operation for relapse, margins were microscopically negative in 77% and 75% of patients, respectively. Median follow-up was 107 months. Results: The 10-year mortality rate was 22% in the absence of local relapse, whereas in locally relapsing patients it was 54% and 43%, respectively, for patients first operated on at our institute and for those who were not. The hazard ratio of positive versus negative surgical margins was 1.7 for cause-specific death and 2.1 for distant metastases in patients first operated on at our institute, as opposed to 1.2 and 1.3 for the others. Conclusions: Local relapse was an unfavorable prognostic factor. In the face of a consistent surgical policy for local relapse in a single-institution setting, patients relapsing after the first operation performed at our institution received rescue treatment less frequently than those previously operated on outside a referral center. This is likely due to an inherently higher tumor aggressiveness. In the presence of such a higher aggressiveness, the adequacy of surgical margins at operation for first relapse seemed more critical prognostically. This may have clinical and speculative implications.

AB - Background: We explored the prognostic meaning of local relapse and surgical margins in adult soft tissue sarcoma of the extremities. Methods: Out of a series of 1017 patients with extremity soft tissue sarcoma treated over 20 years, we picked a group of 238 patients operated on at our institution for their first local relapse: 88 after their primary operation performed at the same center and 150 elsewhere. At operation for relapse, margins were microscopically negative in 77% and 75% of patients, respectively. Median follow-up was 107 months. Results: The 10-year mortality rate was 22% in the absence of local relapse, whereas in locally relapsing patients it was 54% and 43%, respectively, for patients first operated on at our institute and for those who were not. The hazard ratio of positive versus negative surgical margins was 1.7 for cause-specific death and 2.1 for distant metastases in patients first operated on at our institute, as opposed to 1.2 and 1.3 for the others. Conclusions: Local relapse was an unfavorable prognostic factor. In the face of a consistent surgical policy for local relapse in a single-institution setting, patients relapsing after the first operation performed at our institution received rescue treatment less frequently than those previously operated on outside a referral center. This is likely due to an inherently higher tumor aggressiveness. In the presence of such a higher aggressiveness, the adequacy of surgical margins at operation for first relapse seemed more critical prognostically. This may have clinical and speculative implications.

KW - Limbs

KW - Local recurrence

KW - Prognosis

KW - Sarcoma

KW - Surgery

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