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Refining the Approach to Patients with Primary Soft Tissue Sarcoma of the Extremities and Trunk Wall: Outcome Improvement Over Time at a Single Institution

  • Sarcoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The improved outcome of extremity soft tissue sarcoma patients surgically treated until 2007 at the authors’ institution was previously reported. This study updates the analysis at a later follow-up and extends the patients’ cohort to assess changes in outcomes over time for extremity and superficial trunk soft tissue sarcoma (ESTSTS) treated at a single referral center.

Methods

All consecutive patients with primary localized adult-type ESTSTS surgically treated at the authors’ institution between 1987 and 2017 were included and divided into group 1 (1987–2002) and group 2 (2003–2017) according to primary surgery year. Crude cumulative incidence (CCI) of sarcoma-specific mortality (SSM), local recurrence (LR), and distant metastases (DM) were calculated in a competing-risks framework. DM-free survival (DMFS) and post-DM survival were also assessed.

Results

The study identified 2382 patients. The median follow-up was 104 months (range, 63–127 months), and the post-DM follow-up was 76 months (range, 37–126 months). Since 2003, an increased adoption of preoperative treatments was observed: the use of chemotherapy, radiotherapy and combined chemoradiotherapy went from 10.5% to 23.7%, from 1.7% to 17.8%, and from 1% to 11.8% respectively. This change in treatment strategies was associated to an improvement in CCI-SSM (27.8% vs 19.5%; P < 0.001), CCI-LR (14.1 vs 7.5%; P < 0.001), DMFS (57.9% vs 65.8%; P = 0.004), and post-DM (12.2% vs 20.1%; P = 0.012), but not in CCI-DM.

Conclusions

Increased adoption of preoperative treatments and greater availability of medical agents in the recent years were associated to better outcomes. New treatments are eagerly awaited for further improvement of outcome for ESTSTS patients because no major changes have been observed since 2003.

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Authors and Affiliations

  1. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Maria Danieli MD, Marco Fiore MD, Stefano Radaelli MD, Dario Callegaro MD & Alessandro Gronchi MD

  2. Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Francesco Barretta PhD & Rosalba Miceli PhD

  3. Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Claudia Sangalli MD

  4. Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Marta Barisella MD

  5. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Silvia Stacchiotti MD, Elena Palassini MD, Anna Maria Frezza MD & Paolo Giovanni Casali MD

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  1. Maria Danieli MD
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  2. Francesco Barretta PhD
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  3. Marco Fiore MD
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  7. Silvia Stacchiotti MD
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  10. Anna Maria Frezza MD
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  13. Alessandro Gronchi MD
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Correspondence to Alessandro Gronchi MD.

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Danieli, M., Barretta, F., Fiore, M. et al. Refining the Approach to Patients with Primary Soft Tissue Sarcoma of the Extremities and Trunk Wall: Outcome Improvement Over Time at a Single Institution. Ann Surg Oncol 29, 3274–3286 (2022). https://doi.org/10.1245/s10434-021-11189-2

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