Prognostic effect of re-excision in adult soft tissue sarcoma of the extremity

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Abstract

Background: We explored the outcome of patients with primary adult soft tissue sarcoma (STS) of the extremities undergoing re-excision after previous unplanned surgery. Methods: A total of 597 consecutive adult patients with primary extremity STS were treated with conservative surgery at our institution over a 20-year time span. A total of 318 patients were referred after unplanned excisions, and the remaining 279 underwent primary resection at our center. The two groups significantly differed in tumor size and depth. The assessed end points were sarcoma-specific mortality, local recurrence, and distant metastasis. Univariable and multivariable analyses, adjusted for other prognostic factors, were performed in the competing risks framework. Results: The adjusted 10-year cumulative incidences in re-excised and primarily operated patients were, respectively, 18.7% and 16.4% (P = .535) for local relapse, 17.6% and 20.2% (P = .541) for metastasis, and 20.4% and 22.4% (P = .645) for mortality. Among patients who underwent re-excision, evidence of microscopic residual disease on pathologic examina-tion had a significant prognostic effect on multivariable analysis for distant metastases (P = .002). A trend for survival was detected as well. Conclusions: At a referral center with a liberal policy of re-excisions in adult primary STS of the extremities, the outcome of patients who underwent re-excision was similar to that of patients who had primary resections. Evidence of microscopic residual disease at re-excision was a marker of clinical aggressiveness.

Original languageEnglish
Pages (from-to)110-117
Number of pages8
JournalAnnals of Surgical Oncology
Volume13
Issue number1
DOIs
Publication statusPublished - Jan 2006

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Sarcoma
Extremities
Neoplasm Metastasis
Recurrence
Mortality
Referral and Consultation
Biomarkers
Survival
Incidence
Neoplasms

Keywords

  • Limbs
  • Prognosis
  • Re-excision
  • Soft tissue sarcoma
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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title = "Prognostic effect of re-excision in adult soft tissue sarcoma of the extremity",
abstract = "Background: We explored the outcome of patients with primary adult soft tissue sarcoma (STS) of the extremities undergoing re-excision after previous unplanned surgery. Methods: A total of 597 consecutive adult patients with primary extremity STS were treated with conservative surgery at our institution over a 20-year time span. A total of 318 patients were referred after unplanned excisions, and the remaining 279 underwent primary resection at our center. The two groups significantly differed in tumor size and depth. The assessed end points were sarcoma-specific mortality, local recurrence, and distant metastasis. Univariable and multivariable analyses, adjusted for other prognostic factors, were performed in the competing risks framework. Results: The adjusted 10-year cumulative incidences in re-excised and primarily operated patients were, respectively, 18.7{\%} and 16.4{\%} (P = .535) for local relapse, 17.6{\%} and 20.2{\%} (P = .541) for metastasis, and 20.4{\%} and 22.4{\%} (P = .645) for mortality. Among patients who underwent re-excision, evidence of microscopic residual disease on pathologic examina-tion had a significant prognostic effect on multivariable analysis for distant metastases (P = .002). A trend for survival was detected as well. Conclusions: At a referral center with a liberal policy of re-excisions in adult primary STS of the extremities, the outcome of patients who underwent re-excision was similar to that of patients who had primary resections. Evidence of microscopic residual disease at re-excision was a marker of clinical aggressiveness.",
keywords = "Limbs, Prognosis, Re-excision, Soft tissue sarcoma, Surgery",
author = "Marco Fiore and Casali, {Paolo G.} and Rosalba Miceli and Luigi Mariani and Rossella Bertulli and Laura Lozza and Paola Collini and Patrizia Olmi and Chiara Mussi and Alessandro Gronchi",
year = "2006",
month = "1",
doi = "10.1245/ASO.2006.03.030",
language = "English",
volume = "13",
pages = "110--117",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
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TY - JOUR

T1 - Prognostic effect of re-excision in adult soft tissue sarcoma of the extremity

AU - Fiore, Marco

AU - Casali, Paolo G.

AU - Miceli, Rosalba

AU - Mariani, Luigi

AU - Bertulli, Rossella

AU - Lozza, Laura

AU - Collini, Paola

AU - Olmi, Patrizia

AU - Mussi, Chiara

AU - Gronchi, Alessandro

PY - 2006/1

Y1 - 2006/1

N2 - Background: We explored the outcome of patients with primary adult soft tissue sarcoma (STS) of the extremities undergoing re-excision after previous unplanned surgery. Methods: A total of 597 consecutive adult patients with primary extremity STS were treated with conservative surgery at our institution over a 20-year time span. A total of 318 patients were referred after unplanned excisions, and the remaining 279 underwent primary resection at our center. The two groups significantly differed in tumor size and depth. The assessed end points were sarcoma-specific mortality, local recurrence, and distant metastasis. Univariable and multivariable analyses, adjusted for other prognostic factors, were performed in the competing risks framework. Results: The adjusted 10-year cumulative incidences in re-excised and primarily operated patients were, respectively, 18.7% and 16.4% (P = .535) for local relapse, 17.6% and 20.2% (P = .541) for metastasis, and 20.4% and 22.4% (P = .645) for mortality. Among patients who underwent re-excision, evidence of microscopic residual disease on pathologic examina-tion had a significant prognostic effect on multivariable analysis for distant metastases (P = .002). A trend for survival was detected as well. Conclusions: At a referral center with a liberal policy of re-excisions in adult primary STS of the extremities, the outcome of patients who underwent re-excision was similar to that of patients who had primary resections. Evidence of microscopic residual disease at re-excision was a marker of clinical aggressiveness.

AB - Background: We explored the outcome of patients with primary adult soft tissue sarcoma (STS) of the extremities undergoing re-excision after previous unplanned surgery. Methods: A total of 597 consecutive adult patients with primary extremity STS were treated with conservative surgery at our institution over a 20-year time span. A total of 318 patients were referred after unplanned excisions, and the remaining 279 underwent primary resection at our center. The two groups significantly differed in tumor size and depth. The assessed end points were sarcoma-specific mortality, local recurrence, and distant metastasis. Univariable and multivariable analyses, adjusted for other prognostic factors, were performed in the competing risks framework. Results: The adjusted 10-year cumulative incidences in re-excised and primarily operated patients were, respectively, 18.7% and 16.4% (P = .535) for local relapse, 17.6% and 20.2% (P = .541) for metastasis, and 20.4% and 22.4% (P = .645) for mortality. Among patients who underwent re-excision, evidence of microscopic residual disease on pathologic examina-tion had a significant prognostic effect on multivariable analysis for distant metastases (P = .002). A trend for survival was detected as well. Conclusions: At a referral center with a liberal policy of re-excisions in adult primary STS of the extremities, the outcome of patients who underwent re-excision was similar to that of patients who had primary resections. Evidence of microscopic residual disease at re-excision was a marker of clinical aggressiveness.

KW - Limbs

KW - Prognosis

KW - Re-excision

KW - Soft tissue sarcoma

KW - Surgery

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U2 - 10.1245/ASO.2006.03.030

DO - 10.1245/ASO.2006.03.030

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VL - 13

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JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

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