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

  • Symposium: Highlights of the ISOLS/MSTS 2009 Meeting
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

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Author information

Authors and Affiliations

  1. Musculoskeletal Oncology, Mayo Clinic, Rochester, MN, USA

    Eduardo N. Novais MD

  2. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    Bahtiyar Demiralp MD, Joseph Alderete MD, Peter S. Rose MD & Franklin H. Sim MD

  3. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Melissa C. Larson BS

Authors
  1. Eduardo N. Novais MD
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  2. Bahtiyar Demiralp MD
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  3. Joseph Alderete MD
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  4. Melissa C. Larson BS
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  5. Peter S. Rose MD
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  6. Franklin H. Sim MD
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Correspondence to Franklin H. Sim MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Novais, E.N., Demiralp, B., Alderete, J. et al. Do Surgical Margin and Local Recurrence Influence Survival in Soft Tissue Sarcomas?. Clin Orthop Relat Res 468, 3003–3011 (2010). https://doi.org/10.1007/s11999-010-1471-9

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  • DOI: https://doi.org/10.1007/s11999-010-1471-9

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