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 language | English |
|---|---|
| Pages (from-to) | 1583-1590 |
| Number of pages | 8 |
| Journal | Annals of Surgical Oncology |
| Volume | 14 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - May 2007 |
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Keywords
- Limbs
- Local recurrence
- Prognosis
- Sarcoma
- Surgery
ASJC Scopus subject areas
- Surgery
- Oncology
Cite this
Extremity soft tissue sarcoma : Adding to the prognostic meaning of local failure. / Gronchi, Alessandro; Miceli, Rosalba; Fiore, Marco; Collini, Paola; Lozza, Laura; Grosso, Federica; Mariani, Luigi; Casali, Paolo G.
In: Annals of Surgical Oncology, Vol. 14, No. 5, 05.2007, p. 1583-1590.Research output: Contribution to journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=34249032145&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34249032145&partnerID=8YFLogxK
U2 - 10.1245/s10434-006-9325-0
DO - 10.1245/s10434-006-9325-0
M3 - Article
C2 - 17260106
AN - SCOPUS:34249032145
VL - 14
SP - 1583
EP - 1590
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
SN - 1068-9265
IS - 5
ER -