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Published in: Annals of Surgical Oncology 5/2007

01-05-2007 | Bone and Soft Tissue Sarcomas

Extremity Soft Tissue Sarcoma: Adding to the Prognostic Meaning of Local Failure

Authors: Alessandro Gronchi, MD, Rosalba Miceli, PhD, Marco Fiore, MD, Paola Collini, MD, Laura Lozza, MD, Federica Grosso, MD, Luigi Mariani, MD, Paolo G. Casali, MD

Published in: Annals of Surgical Oncology | Issue 5/2007

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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.
Literature
1.
go back to reference Gronchi A, Casali PG, Mariani L, et al. Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of 911 consecutive patients treated at a single institution. J Clin Oncol 2005; 23:96–104PubMedCrossRef Gronchi A, Casali PG, Mariani L, et al. Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of 911 consecutive patients treated at a single institution. J Clin Oncol 2005; 23:96–104PubMedCrossRef
2.
go back to reference Lewis JJ, Leung DHY, Casper ES, et al. Multifactorial analysis of long-term follow-up (more than 5 years) of primary extremity sarcoma. Arch Surg 1999; 134:190–4PubMedCrossRef Lewis JJ, Leung DHY, Casper ES, et al. Multifactorial analysis of long-term follow-up (more than 5 years) of primary extremity sarcoma. Arch Surg 1999; 134:190–4PubMedCrossRef
3.
go back to reference Trovik CS, Bauer HCF, Alvegard TA, et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 surgically-treated patients from the Scandinavian Sarcoma Group register. Eur J Cancer 2000; 36:710–6PubMedCrossRef Trovik CS, Bauer HCF, Alvegard TA, et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 surgically-treated patients from the Scandinavian Sarcoma Group register. Eur J Cancer 2000; 36:710–6PubMedCrossRef
4.
go back to reference Stojadinovic A, Leung DHY, Hoos A, et al. Analysis of the prognostic significance of microscopic margins in 2084 localized primary adult soft tissue sarcomas. Ann Surg 2002; 235:424–33PubMedCrossRef Stojadinovic A, Leung DHY, Hoos A, et al. Analysis of the prognostic significance of microscopic margins in 2084 localized primary adult soft tissue sarcomas. Ann Surg 2002; 235:424–33PubMedCrossRef
5.
go back to reference Zagars GK, Ballo MT, Pisters PWT, et al. Prognostic factors for patients with localized soft tissue sarcoma treated with conservation surgery and radiation therapy. An analysis of 1225 patients. Cancer 2003; 97:2530–43PubMedCrossRef Zagars GK, Ballo MT, Pisters PWT, et al. Prognostic factors for patients with localized soft tissue sarcoma treated with conservation surgery and radiation therapy. An analysis of 1225 patients. Cancer 2003; 97:2530–43PubMedCrossRef
6.
go back to reference Eilber FC, Rosen G, Nelson SD, et al. High grade extremity soft tissue sarcomas. Factor predictive of local recurrence and its effect on morbidity and mortality. Ann Surg 2003; 237:218–26PubMedCrossRef Eilber FC, Rosen G, Nelson SD, et al. High grade extremity soft tissue sarcomas. Factor predictive of local recurrence and its effect on morbidity and mortality. Ann Surg 2003; 237:218–26PubMedCrossRef
7.
go back to reference Kawaguchi N, Ahmed AR, Matsumoto S, et al. The concept of curative margin in surgery for bone and soft tissue sarcoma. Clin Orthop 2004; 419:165–172PubMedCrossRef Kawaguchi N, Ahmed AR, Matsumoto S, et al. The concept of curative margin in surgery for bone and soft tissue sarcoma. Clin Orthop 2004; 419:165–172PubMedCrossRef
8.
go back to reference Stoeckle E, Gardet H, Coindre JM, et al. Prospective evaluation of quality of surgery in soft tissue sarcoma. Eur J Surg Oncol 2006; 32:1242–8PubMedCrossRef Stoeckle E, Gardet H, Coindre JM, et al. Prospective evaluation of quality of surgery in soft tissue sarcoma. Eur J Surg Oncol 2006; 32:1242–8PubMedCrossRef
10.
go back to reference Gustafson P, Rooser B, Rydholm A. Is local recurrence of minor importance for metastases in soft tissue sarcoma? Cancer 1991; 67:2083–6PubMedCrossRef Gustafson P, Rooser B, Rydholm A. Is local recurrence of minor importance for metastases in soft tissue sarcoma? Cancer 1991; 67:2083–6PubMedCrossRef
11.
go back to reference Gustafson P, Dreinhofer KE, Rydholm A. Metastasis-free survival after local recurrence of soft tissue sarcoma. J Bone Joint Surg Br 1993; 75:658–60PubMed Gustafson P, Dreinhofer KE, Rydholm A. Metastasis-free survival after local recurrence of soft tissue sarcoma. J Bone Joint Surg Br 1993; 75:658–60PubMed
12.
go back to reference Singer S, Corson K, Gonin JM, et al. Prognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg 1994; 219:165–73PubMedCrossRef Singer S, Corson K, Gonin JM, et al. Prognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg 1994; 219:165–73PubMedCrossRef
13.
go back to reference Lewis JJ, Leung DHY, Heslin M, et al. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol 1997; 15:646–52PubMed Lewis JJ, Leung DHY, Heslin M, et al. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol 1997; 15:646–52PubMed
14.
go back to reference Ueda T, Yoshikawa H, Mori S, et al. Influence of local recurrence on the prognosis of soft tissue sarcoma. J Bone Joint Surg Br 1997; 79:553–7PubMedCrossRef Ueda T, Yoshikawa H, Mori S, et al. Influence of local recurrence on the prognosis of soft tissue sarcoma. J Bone Joint Surg Br 1997; 79:553–7PubMedCrossRef
15.
go back to reference Trovik CS, Gustafson P, Bauer HC, et al. Consequences of local recurrence of soft tissue sarcoma: 205 patients from the Scandinavia Sarcoma Group register. Acta Orthop Scand 2000; 71:488–95PubMedCrossRef Trovik CS, Gustafson P, Bauer HC, et al. Consequences of local recurrence of soft tissue sarcoma: 205 patients from the Scandinavia Sarcoma Group register. Acta Orthop Scand 2000; 71:488–95PubMedCrossRef
16.
go back to reference Ramanathan RC, A’Hern RA, Fisher C, et al. Prognostic index for extremity soft tissue sarcomas with isolated local recurrence. Ann Surg Oncol 2001; 8:278–89PubMedCrossRef Ramanathan RC, A’Hern RA, Fisher C, et al. Prognostic index for extremity soft tissue sarcomas with isolated local recurrence. Ann Surg Oncol 2001; 8:278–89PubMedCrossRef
17.
go back to reference Moureau-Zabotto L, Thomas L, Bui BN, et al. Management of soft tissue sarcomas (STS) in first isolated local recurrence: a retrospective study of 83 cases. Radiother Oncol 2004; 73:313–9PubMedCrossRef Moureau-Zabotto L, Thomas L, Bui BN, et al. Management of soft tissue sarcomas (STS) in first isolated local recurrence: a retrospective study of 83 cases. Radiother Oncol 2004; 73:313–9PubMedCrossRef
18.
go back to reference Eilber FC, Brennan MF, Riedel E, et al. Prognostic factors for survival in patients with locally recurrent extremity soft tissue sarcomas. Ann Surg Oncol 2005; 12:228–36PubMedCrossRef Eilber FC, Brennan MF, Riedel E, et al. Prognostic factors for survival in patients with locally recurrent extremity soft tissue sarcomas. Ann Surg Oncol 2005; 12:228–36PubMedCrossRef
19.
go back to reference Trojani M, Contesso G, Coindre JM, et al. Soft tissue sarcomas of adults: study of pathological prognostic variables and definition of a histopathologic grading system. Int J Cancer 1984; 33:37–42. PubMedCrossRef Trojani M, Contesso G, Coindre JM, et al. Soft tissue sarcomas of adults: study of pathological prognostic variables and definition of a histopathologic grading system. Int J Cancer 1984; 33:37–42. PubMedCrossRef
20.
go back to reference Kattan MW, Leung DHY, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol 2002; 20:791–6PubMedCrossRef Kattan MW, Leung DHY, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol 2002; 20:791–6PubMedCrossRef
21.
go back to reference Eilber FC, Brennan MF, Eilber FR, et al. Validation of the postoperative nomogram for 12-year sarcoma-specific mortality. Cancer 2004; 101:2270–5PubMedCrossRef Eilber FC, Brennan MF, Eilber FR, et al. Validation of the postoperative nomogram for 12-year sarcoma-specific mortality. Cancer 2004; 101:2270–5PubMedCrossRef
22.
go back to reference Mariani L, Miceli R, Kattan MW, et al. Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer 2005; 103:402–8PubMedCrossRef Mariani L, Miceli R, Kattan MW, et al. Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer 2005; 103:402–8PubMedCrossRef
23.
go back to reference Rosenberg SA, Tepper J, Glatsein E, et al. The treatment of soft tissue sarcoma of the extremities: prospective randomized evaluation of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982; 196:305–15PubMedCrossRef Rosenberg SA, Tepper J, Glatsein E, et al. The treatment of soft tissue sarcoma of the extremities: prospective randomized evaluation of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982; 196:305–15PubMedCrossRef
24.
go back to reference Pisters PWT, Harrison LB, Leung DHY, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996; 14:859–68PubMed Pisters PWT, Harrison LB, Leung DHY, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996; 14:859–68PubMed
25.
go back to reference Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998; 16:197–203PubMed Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998; 16:197–203PubMed
Metadata
Title
Extremity Soft Tissue Sarcoma: Adding to the Prognostic Meaning of Local Failure
Authors
Alessandro Gronchi, MD
Rosalba Miceli, PhD
Marco Fiore, MD
Paola Collini, MD
Laura Lozza, MD
Federica Grosso, MD
Luigi Mariani, MD
Paolo G. Casali, MD
Publication date
01-05-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9325-0

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