Clinicopathological assessment of T1 soft tissue sarcomas

Abstract

Many studies have identified factors prognostic for soft tissue sarcomas of local recurrence, and distant metastasis. Several studies demonstrated that some subsets of patients could be safely treated by surgery alone, with acceptable rates of local recurrence. The aim of this study was to better clarify the necessity for adjuvant therapy and the width of the resected margin, by investigating the clinicopathological results of T1 (≤5 cm) soft tissue sarcomas. A retrospective review was conducted in 96 adult patients treated for nonmetastatic AJCC T1 primary non-small round cell soft tissue sarcomas in our institution from 1995 to 2008. There were 49 men and 47 women ranging in age from 18 to 85 years (mean 51), and the observation period was 6-159 months (mean 52). The site of origin was the upper extremity in 21 cases, the lower extremity in 45, and the trunk in 30. Forty-four cases had high-grade malignant tumors, and 52 had low-grade malignant ones. Tumor size ranged from 0.7 to 5.0 cm (median size, 3.5 cm). Thirty-nine cases (41%) had previously undergone unplanned excision elsewhere. Eighty-nine (93%) of the patients were continuously free of disease, four were alive and currently free of disease, one was alive with metastasis, and two had died. The event-free survival rate at 5 years was 93.3%. The overall survival rate at 5 years was 94.1%. In 23 of the 45 cases with unplanned excisions (51%) residual tumor was found on histological examination. After definitive surgery, 92 patients (96%) had R0 margins. Four patients (4%) had R1 margins and were treated with postoperative radiotherapy. Forty-five of 51 cases after planned biopsies (88%) showed infiltrative growth microscopically. Tumor size was found to have a major impact on the prognosis of soft tissue sarcomas, emphasizing the importance of early detection and early treatment of these tumors. Most patients suffering from T1 soft tissue sarcomas might be able to avoid adjuvant therapies including radiotherapy and chemotherapy. To achieve good local control with surgery alone, an adequate surgical margin must be achieved even for small lesions.