Abstract
High grade soft tissue sarcomas often show histological invasion to adjacent compartment including bone and vessel. This study aimed to evaluate histological invasion in high grade soft tissue sarcomas, clarify its impact on prognosis and devise treatment strategies. We retrospectively reviewed 133 patients with non-small round cell high grade soft tissue sarcomas surgically treated between 2001 and 2011. Clinical and histological factors examined for prognostic value included age, gender, size, depth, location, adjuvant therapy and invasion to adjacent compartment. Study endpoints included overall survival rate, event free survival rate and local recurrence free survival rate, estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using the log-rank test and Cox proportional hazards model. Local recurrence was recognized in 14 cases (11%). The 5-year overall survival rate and 5-year event free survival rate were 82.2% and 63.6% respectively. The metastasis-free survival rate at 5 years and local recurrence-free survival rate at 5 years were 69.8% and 86.8% respectively. Histological invasion to adjacent compartment was noted in 52 cases (39%), and was significantly correlated with histological type (p = 0.01), tumor size (p = 0.009), and depth (p < 0.05). In multivariate analyses, we showed that tumor size and histological invasion were significant independent predictors of OS (hazard ratio 8.1/2.5) and EFS (hazard ratio 5.5/2.2), while only tumor size was a significant independent predictor of LRFS (hazard ratio 4.0). We evaluated the relation between histological invasion and the oncological outcomes of high grade soft tissue sarcomas. In multivariate analyses, histological invasion was found to be an independent adverse prognostic factor with hazard ratios of 2.2-2.5, suggesting that a detailed assessment of these factors is essential. Histological invasion showed a correlation with tumor size and histological type, and the surgical margin should be decided based on these factors.
Highlights
Soft tissue sarcoma is an uncommon cancer with variable histological subtypes and clinical behaviors
Once metastases develop most patients die of their disease
Soft tissue sarcomas are characterized by aggressive histological invasiveness, which has been correlated with their prognosis (Gustafson et al 2003; Carneiro et al 2011)
Summary
Soft tissue sarcoma is an uncommon cancer with variable histological subtypes and clinical behaviors. Numerous studies have identified clinical prognostic factors that could influence survival and local recurrence of soft tissue sarcoma (Behranwala et al 2004; Carneiro et al 2011; Coindre et al 1996; Collin et al 1987; Eilber et al 2004; Eilber et al 2003; Gaynor et al 1992; Heise et al 1986; Kattan et al 2002; Lahat et al 2008; McKee et al 2004; Mutter et al 2012; Pisters et al 1996; Ramanathan et al 1999; Riad et al 2004; Rööser et al 1988; Singer et al 1994; Stefanovski et al 2002; Stojadinovic et al 2002; Stotter et al 1990; Trojani et al 1984; Ueda et al 1988; Zagars et al.2003). It is important to recognize to what extent this kind of histological invasion is detected in high grade sarcomas, and what influence it exerts on survival and local recurrence
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