Analysis of Prognostic Factors In Adult Patients With Localized Soft Tissue Sarcomas of The Extremities
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Background: Soft tissue sarcomas (STS) of the extremities represent a diverse histologic group of malignancies at risk for local failure and distant metastasis. Aim of the work: The aim of this study was to evaluate the relationships between various clinicopathologic factors and the oncologic end points local recurrence, distant metastasis, local recurrence free-survival, metastasis free-survival, and overall survival. To identify prognostic variables that could be used to select patients most likely to benefit from adjuvant or neoadjuvant treatment in future trials. Patients and methods: Eighty seven patients with a non-metastatic and locally controlled STS, collected during the period 1995 through 2000 from Minoufiya University Hospital and Benha University Hospital, were studied. Patient, tumor, and pathologic factors were analyzed by univariate and multivariate techniques. The overall 5- year survival rate for the whole series was 53% (median 50; mean: 50.5±19.6; range, 12-60 months) with a median follow-up time of 35 months. The local recurrence free-survival and metastasis freesurvival rates at 5-years were 53% and 52%, respectively. The median post-metastasis survival was 15 months (mean: 15.7±40.9; range, 4-23). Results: Twenty-three (26.4%) local recurrences and 21(24.1%) distant metastases were noted. The median time to development of local recurrence and distant metastasis were 19 and 29 months, respectively. By multivariate analysis the significant independent adverse prognostic factors for local recurrence were: positive microscopic surgical margins (P= 0.0001) and high histologic grade 0.001) and tumor size greater than 10cm (P= 0.003). For overall survival were: positive microscopic surgical margins (P= 0.005), high histologic grade (P= 0.007), and tumor size greater than 10cm (P= 0.02). There was a significant association of local recurrence with the development of subsequent distant metastasis and poor overall survival, and that local recurrence is a poor prognostic factor (P= 0.0001). Conclusion: Grade, microscopic surgical margins, and tumor size could be used to select patients with a high metastatic risk, for which adjuvant treatments could be beneficial. Patients with local recurrence are at increased risk for subsequent distant metastasis and poor overall survival.