Abstract
ObjectiveThe purpose of this retrospective study was to identify the prognostic significance of time to local recurrence (TLR) with regard to overall survival (OS) and survival after local recurrence (SAR) in patients with soft tissue sarcoma (STS) of the extremity and abdominothoracic wall.MethodsWe identified 477 patients who underwent R0 resection for localized STS of the extremity and abdominothoracic wall, from January 1995 to December 2016, of whom 190 patients developed local recurrence as their first recurrent event. Based on TLR, patients were divided into two groups: early local recurrence (ELR, <12 months) and late local recurrence (LLR, ≥12 months). The Kaplan–Meier method and Cox regression analysis were used to estimate the OS and SAR, and to identify factors associated with patient outcomes.ResultsThe median follow-up time for the entire cohort was 118.4 months, and was 118.5 months for the 190 patients who developed local recurrence. Deep tumor location (HR 1.73, 95% CI 1.27–2.37, P = 0.001) and tumor grade ≥2 (G2 vs. G1: HR 1.75, 95% CI 1.21–2.53, G3 vs. G1: HR 2.57, 95% CI 1.66–3.98, P < 0.001) were associated with a higher rate of local recurrence. There were 99 patients in the ELR group and 91 in the LLR group, with a median TLR of 10.8 months for the entire cohort. Patients from the ELR group had a shorter OS and a lower 5-year OS rate than the LLR group. Univariate and multivariate analyses demonstrated TLR as an independent prognostic factor for SAR and OS, in addition to tumor grade. Also, surgical treatment and absence of metastasis after local recurrence were associated with longer SAR.ConclusionsIn patients with STS of the extremity and abdominothoracic wall, ELR after R0 resection indicated a worse prognosis than those with LLR, and TLR can be considered an independent prognostic factor for OS and SAR. Furthermore, local recurrence was significantly influenced by the depth and the histopathological grading of the primary tumor, and reoperation after local recurrence could improve survival, which means salvage surgery may still be the preferred treatment when there are surgical indications after recurrence.
Highlights
Soft tissue sarcomas (STSs) are a heterogeneous group of malignancies with a low incidence, accounting for approximately 1% of all adult malignancies [1]
Deep tumor location (HR 1.73, 95% confidence intervals (95% CI) 1.27–2.37, P = 0.001) and tumor grade ≥2 (G2 vs. G1: hazard ratios (HR) 1.75, 95% CI 1.21–2.53, G3 vs. G1: HR 2.57, 95% CI 1.66–3.98, P < 0.001) were associated with a higher rate of local recurrence
Surgical treatment and absence of metastasis after local recurrence were associated with longer survival after recurrence (SAR)
Summary
Soft tissue sarcomas (STSs) are a heterogeneous group of malignancies with a low incidence, accounting for approximately 1% of all adult malignancies [1]. STSs may arise in different body sites, including the head or neck, extremity, trunk, retroperitoneum, or chest wall, with local aggressiveness. The anatomic sites and pathologic subtypes of these tumors are crucial for their treatments and outcomes. Despite the established role of radical or wide surgical resection as a standard of treatment, 15%–40% of patients with localized STS tumors develop recurrence and have a dismal 5year survival rate ranging between 55% and 70% [2, 3]. Tumor local relapse remains one of the major problems in managing STS, and can be defined as early or late recurrence. Renal cell carcinoma, and gastric cancer, it was previously reported that patients with late recurrence had better prognosis than those with early recurrence [4,5,6]. To the best of our knowledge, neither significant factors affecting the survival after recurrence (SAR) for STS patients nor information concerning the prognostic significance of time to local recurrence (TLR) in STS patients have been reported
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