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. |
