Prognosis in soft tissue sarcoma.

Abstract

Consensus is still lacking as regards which surgical procedures carry a low risk of local recurrence in soft tissue sarcoma. A series of 81 patients with Grades I-IV soft tissue sarcomas of the locomotor system, with a minimum follow-up time of 6 years, was studied with respect to local recurrence. All the patients were operated on with wide surgical margins without adjunctive therapy. A subclassification of these margins was performed. A wide F margin, obtained by myectomy of one or several muscles, but not of the total compartment, was found to be a safe procedure, giving a local recurrence rate of less than 0.1. This applied when surgery was performed without a preceding open biopsy. For subcutaneous tumors a wide S margin, including the deep fascia, also resulted in a small local recurrence rate, even if performed after incisional biopsy or marginal surgery. More than one half of all patients with soft tissue sarcoma in the locomotor system have tumors suitable for surgical treatment with a wide F or a wide S margin for a low local recurrence risk. A wide margin where the surgical dissection had transgressed the muscle where the tumor was located or areolar tissue in cases of extramuscular tumor (wide AM margin) was found to result in a higher local recurrence rate, around 0.25. There is no generally accepted staging system for soft tissue sarcomas. Those systems in most common use were not constructed after statistical multivariate analysis, whereby the strongest prognostic factors may be identified. The staging system of the American Joint Committee (AJC), the system of Hajdu, and the Surgical Staging System (SSS) were evaluated with respect to their ability to discriminate patients with different chances for survival in a series of 122 patients operated on with wide or radical surgical margins. None of the three systems could identify patient-groups with a significantly different prognosis better than that, that could simply be done by the histologic malignancy grading of the tumors. A multivariate analysis of variables thought to be of prognostic significance for local recurrence and survival was performed in a series of 144 patients with Grades III and IV soft tissue sarcomas. Marginal surgery, extracompartmental tumor location, and tumor necrosis increased the risk of local recurrence. Local recurrence, male sex, malignancy grade IV, tumor necrosis, and increasing tumor size increased the risk of tumor-related death.(ABSTRACT TRUNCATED AT 400 WORDS)