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Prognostic Factors for Survival in Patients With Locally Recurrent Extremity Soft Tissue Sarcomas

Annals of Surgical Oncology volume 12, pages 228–236 (2005)Cite this article

Abstract

Background

Factors prognostic for survival in patients with locally recurrent extremity soft tissue sarcomas (STS) are poorly defined, thus making it difficult to identify high-risk patients who may benefit from adjuvant therapy.

Methods

A total of 1421 patients underwent surgical treatment for primary extremity STS at a single institution between 1982 and 2002. Of these, 179 (13%) patients underwent complete surgical resection of an isolated local recurrence and were the subjects of this study. Clinicopathologic factors from both the primary tumor and the local recurrence were analyzed.

Results

The median interval to initial local recurrence was 16 months: 65% developed a local recurrence by 2 years and 90% by 4 years. Only four patients who presented with a low-grade primary tumor progressed to a high-grade local recurrence. Independent prognostic factors for disease-specific survival after local recurrence were a high histological grade (hazard ratio, 5.1; P = .0004), a large local recurrence tumor size (hazard ratio, 1.5; P = .0001), and a short local recurrence–free interval (hazard ratio, 1.6; P = .0001). Patients who developed a local recurrence >5 cm in ≤16 months (n = 44; 0 low grade) had a 4-year disease-specific survival of 18%, compared with 81% for patients who developed a local recurrence ≤5 cm in >16 months (n = 46; 11 low grade).

Conclusions

Histological grade, local recurrence size, and local recurrence–free interval are independently predictive of survival in patients with locally recurrent extremity STS. A large local recurrence that develops in a short interval indicates a biologically aggressive tumor with a high tumor-specific mortality. Patients who develop such recurrences are ideal subjects for systemic neoadjuvant therapy trials.

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Acknowledgments

Supported by National Institutes of Health Program Project Grant P01CA47179 (M.F.B. and S.S.) and a Kristen Ann Carr Fellowship (F.C.E.).

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Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021

    Fritz C. Eilber MD, Murray F. Brennan MD & Samuel Singer MD

  2. Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021

    Elyn Riedel MA

  3. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021

    Kaled M. Alektiar MD

  4. Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021

    Cristina R. Antonescu MD

Authors
  1. Fritz C. Eilber MD
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  2. Murray F. Brennan MD
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  3. Elyn Riedel MA
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  4. Kaled M. Alektiar MD
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  5. Cristina R. Antonescu MD
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  6. Samuel Singer MD
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Corresponding author

Correspondence to Samuel Singer MD.

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Eilber, F.C., Brennan, M.F., Riedel, E. et al. Prognostic Factors for Survival in Patients With Locally Recurrent Extremity Soft Tissue Sarcomas. Ann Surg Oncol 12, 228–236 (2005). https://doi.org/10.1245/ASO.2005.03.045

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  • DOI: https://doi.org/10.1245/ASO.2005.03.045

Keywords

  • Local recurrence
  • Extremity soft tissue sarcoma
  • Prognostic factors
  • Adjuvant therapy