Vascular Proximity Increases the Risk of Local Recurrence in Soft-Tissue Sarcomas of the Thigh-A Retrospective MRI Study.

Andrea Sambri,Michele Fiore,Davide Maria Donati,Giuseppe Bianchi,Federico Ponti,Marco Miceli,Paolo Spinnato,Luca Cevolani,Andrea Montanari,Valerio D’Agostino,Emilia Caldari,Massimiliano De Paolis

doi:10.3390/cancers13246325

Abstract

Simple SummaryProximity to major vessels increases risk of local recurrence in soft tissue sarcomas of the thigh. When major vessels were observed to be surrounded by the tumor on preoperative MRI, vascular resection and by-pass reconstruction offered a better local control.The aim of this study was to establish the prognostic effects of the proximity of the tumor to the main vessels in patients affected by soft tissue sarcomas (STS) of the thigh. A total of 529 adult patients with deeply seated STS of the thigh and popliteal fossa were included. Vascular proximity was defined on MRI: type 1 > 5 mm; type 2 ≤ 5 mm and >0 mm; type 3 close to the tumor; type 4 enclosed by the tumor. Proximity to major vessels type 1–2 had a local recurrence (LR) rate lower than type 3–4 (p < 0.001). In type 4, vascular by-pass reduced LR risk. On multivariate analysis infiltrative histotypes, high FNLCC grade, radiotherapy administration, and type 3–4 of proximity to major vessels were found to be independent prognostic factors for LR. We observed an augmented risk of recurrence, but not of survival as the tumor was near to the major vessels. When major vessels were found to be surrounded by the tumor on preoperative MRI, vascular resection and bypass reconstruction offered a better local control.

Highlights

Soft tissue sarcomas (STS) of the limbs include a large variety of histologies, sizes, and grades, with clear and significant variances in their clinical course and prognosis [1]
The tumour was attached to major vessels in 108 (20.4%) of the cases and surrounded by the tumor 75 (14.2%)
Proximity to major vessels was observed to be an independent prognostic factor for local recurrence in primary STS of the thigh and popliteal fossa, providing a possible prognostic estimation based on preoperative Magnetic Resonance Imaging (MRI) assessment

Summary

Introduction

Soft tissue sarcomas (STS) of the limbs include a large variety of histologies, sizes, and grades, with clear and significant variances in their clinical course and prognosis [1]. Despite these intrinsic varieties, STS are very rare tumors, which represent only 1% of all malignancies considering all locations in the adult population. STS are very rare tumors, which represent only 1% of all malignancies considering all locations in the adult population These variabilities, together with a lack of knowledge of these rare cancers among general practitioners, often lead to a delayed presentation at referral centers [2]. There is still disagreement on which are the most appropriate surgical strategies when the tumor involves the principal vessels of the limb

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