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Bone metastasis in extremity soft tissue sarcomas: risk factors and survival analysis using the SEER registry

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Abstract

Introduction

While lung is the most common site of metastasis, bone metastasis of soft tissue sarcoma is a part of the natural history affecting the prognosis of these patients. To date, no studies have analyzed the histologic subtypes more likely to metastasize to bone, the risk factors for bone metastasis at initial presentation, or the effect that bone metastasis has on the survival of these patients.

Material/methods

Patients were identified from the Surveillance, Epidemiology and End Results database with primary extremity STS between 2010 and 2015. Risk factors for early bone metastasis, survival based on different sites of metastasis, and prognostic factors of survival were analyzed.

Results

Among 8,234 STS, 2.2% (n = 180) presented with skeletal metastasis. Bone metastasis was more likely when regional lymph nodes were involved (OR = 4.48, p = 0.008). Deep and moderate or high-grade sarcomas had 5–12-fold tendency to present with bone and lung metastasis (p = 0.046, 0.006, 0.030, respectively). The 5-year survival rate was 41.2% (26.9–54.9%) for isolated bone metastasis and 32.9% (21.2–45.1%) for patients with bone and lung metastasis. Resection of the primary sarcoma was the only significant predictor of survival (HR = 0.44, p = 0.021) for patients with bone metastasis.

Conclusion

High tumor grade, deep location to fascia and regional lymph node metastasis are significant risk factors for skeletal metastasis at diagnosis of an extremity STS. While neither systemic chemotherapy nor radiotherapy of the primary sarcoma has a significant influence on survival in the presence of bone metastasis, radical resection of the primary STS is associated with increased survival.

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Data availability

The data that support the findings of this study are openly available in the SEER Repository at https://seer.cancer.gov/data/.

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Funding

No outside funding was obtained for this study.

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Authors and Affiliations

  1. Musculoskeletal Oncology Division, Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Fourth Floor, Room 4036, Miami, FL, 33136, USA

    M. H. Younis, S. Summers & J. Pretell-Mazzini

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  1. M. H. Younis
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  2. S. Summers
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  3. J. Pretell-Mazzini
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Correspondence to J. Pretell-Mazzini.

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Younis, M.H., Summers, S. & Pretell-Mazzini, J. Bone metastasis in extremity soft tissue sarcomas: risk factors and survival analysis using the SEER registry. Musculoskelet Surg 106, 59–68 (2022). https://doi.org/10.1007/s12306-020-00673-9

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  • DOI: https://doi.org/10.1007/s12306-020-00673-9

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