Do Surgical Margin and Local Recurrence Influence Survival in Soft Tissue Sarcomas?

• Published in: Clinical orthopaedics and related research 2010-11, Vol.468 (11), p.3003-3011
• Main Authors: Novais, Eduardo N., Demiralp, Bahtiyar, Alderete, Joseph, Larson, Melissa C., Rose, Peter S., Sim, Franklin H.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Conservative Orthopedics; Extremities; Female; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Minnesota - epidemiology; Neoplasm Recurrence, Local - mortality; Neoplasm Staging; Orthopedics; Proportional Hazards Models; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Sarcoma - mortality; Sarcoma - secondary; Sarcoma - surgery; Soft Tissue Neoplasms - mortality; Soft Tissue Neoplasms - pathology; Soft Tissue Neoplasms - surgery; Sports Medicine; Surgery; Surgical Orthopedics; Survival Rate; Symposium: Highlights of the ISOLS/MSTS 2009 Meeting; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-010-1471-9

Background Established prognostic factors influencing survival in soft tissue sarcomas include tumor stage, histopathologic grade, size, depth, and anatomic site. The presence of tumor near or at the margin of resection increases the risk of local recurrence but whether a positive surgical margin or local recurrence affect overall survival is controversial. Questions/purposes We explored the impact of microscopic margin on local recurrence, metastasis, and overall survival in patients with intermediate- to high-grade soft tissue sarcomas of the extremities. We then determined whether local recurrence decreases overall survival. Methods We retrospectively reviewed the medical records of 248 patients who had soft tissue sarcomas of the extremities treated surgically from 1995 to 2008. We estimated survival, local recurrence, and distant metastasis and examined factors potentially influencing these outcomes. The minimum followup was 0.4 years (median, 4.4 years; range, 0.4–13 years). Results The 5-year cumulative incidence of local recurrence was 4.1%. Patients who presented with positive margins or a margin of 2 mm or less had a worse survival than patients who had margins of greater than 2 mm and wide margins (5-year survival, 47% versus 70% and 72%). In addition to surgical margin, developing metastasis, tumor response of less than 90% necrosis, high histopathologic grade, high AJCC stage (Stage III), increasing age, and male gender were associated with decreased overall survival. Local recurrence independently predicted decreased overall survival. Conclusions Microscopic surgical margin and local recurrence after surgical treatment should be included as risk factors predicting decreased overall survival for intermediate- to high-grade soft tissue sarcomas of the extremities. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.