Prognostic factors and outcome of spermatic cord sarcoma.

Abstract

To evaluate management and outcome in a large series of patients with spermatic cord sarcomas (SCS), a rare malignancy. Eighty-two patients with localized SCS treated at two dedicated sarcoma units between 1992 and 2013 were included. Disease-specific survival (DSS) and crude cumulative incidence of local recurrence and distant metastases (DM) were estimated by Kaplan-Meier plots and log rank tests. Median follow-up was 33months (interquartile range 13-72months). Sixty-one patients presented with primary disease. Liposarcoma was the most common histotype, but surprisingly, 37% of tumors were of high grade. Seventeen patients (21%) received radiotherapy and 12 patients (15%) chemotherapy. Five-year DSS for the whole series was 92% [95% confidence interval (CI) 83-97]. Five-year rates of local recurrence and DM were 26% (95% CI 15-42) and 24% (95% CI 15-38), respectively. Tumor grade was found to be a significant predictor of both DSS and DM (both p<0.001). Quality of surgical margins was proved to affect the local outcome (p=0.025), while the rates of distant metastases were found to differ significantly by histology (p=0.010). Exclusively in the liposarcoma subgroup, quality of surgical margins was also directly associated with DSS (p=0.043). Wide excision of the tumor is critical for cure, especially in the liposarcoma subgroup. The role of radiotherapy and chemotherapy is not established.