Abstract
Background Many studies have reported on the surgical outcomes of soft tissue sarcoma. However, there was no longitudinal cohort study. Because time is the most valuable factor for functional recovery, adjusting time value was the key for finding the causal relationship between other risk factors and postoperative function. Therefore, existing cross-sectional studies can neither fully explain the causal relationship between the risk factors and the functional score nor predict functional recovery. The aim of this study was to determine important predictive factors that affect postoperative functional outcomes and longitudinal changes in functional outcomes in patients who had undergone limb-sparing surgery (LSS) for soft tissue sarcoma (STS). Methods Between January 2008 and December 2014, we retrospectively enrolled 150 patients who had undergone LSS for STS and had been assessed for postoperative functional outcomes with questionnaires. To evaluate functional outcomes, we used the Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). Multivariate generalized estimating equation (GEE) analysis was used to identify the predictive factors, including size, stage, and anatomic location of tumor, bone resection, flap reconstruction, age, and time after surgery. Each continuous variable such as age and time after surgery was explored for statistically significant cutoff points using the Wilcoxon rank sum test. Results Functional scores significantly improved until the second year after surgery and plateaued for the rest of the 5-year period. Age (p < 0.0001), bone resection (p=0.0004), and time after surgery (p < 0.0001) were identified as significant predictive factors. The functional score was significantly higher in patients younger than 47 years old. Conclusions Functional outcomes can improve until the second year after surgery. Patients who were older than 47 and underwent bone resection may have poor final functional outcomes.
Highlights
Soft tissue sarcomas (STSs) are rare malignant tumors, representing approximately 1% of all adult cancers [1]
Results e characteristics of all 150 patients, comprising 81 men (54%) and 69 women (46%), are listed in Table 1. e mean age at the time of surgery was 47 years. e distribution graphics of functional scores in the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) are shown in Figures 1 and 2. e functional scores in the MSTS and TESS significantly improved until the second year after surgery and remained stable for the rest of the 5-year period. e optimal cutoff was chosen as 24 months, based on the most significant Wilcoxon rank sum test p value for all possible cutoff points
Older patients scored lower than younger patients in functional outcomes. e optimal cutoff was chosen as 47 years old, based on the most significant Wilcoxon rank sum test p value for all possible cutoff points
Summary
Soft tissue sarcomas (STSs) are rare malignant tumors, representing approximately 1% of all adult cancers [1]. Ese studies have limitations in not using longitudinal data with more than 2 time points and by not examining various predictors of postoperative functional outcomes for periods exceeding 5 years. With such reports, surgeons are Sarcoma not able to inform patients about the functional recovery period and final outcome after surgery. E aim of this study was to determine important predictive factors that affect postoperative functional outcomes and longitudinal changes in functional outcomes in patients who had undergone limb-sparing surgery (LSS) for soft tissue sarcoma (STS). Multivariate generalized estimating equation (GEE) analysis was used to identify the predictive factors, including size, stage, and anatomic location of tumor, bone resection, flap reconstruction, age, and time after surgery. Patients who were older than 47 and underwent bone resection may have poor final functional outcomes
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