Outcome Of Soft Tissue Sarcomas Research Articles

Macrophage Migration Inhibitory Factor and Stearoyl-CoA Desaturase 1: Potential Prognostic Markers for Soft Tissue Sarcomas Based on Bioinformatics Analyses

The diagnosis and treatment of soft tissue sarcomas (STSs) has been particularly difficult, because STSs are a group of highly heterogeneous tumors in terms of histopathology, histological grade, and primary site. Recent advances in genome technologies have provided an excellent opportunity to determine the complete biological characteristics of neoplastic tissues, resulting in improved diagnosis, treatment selection, and investigation of therapeutic targets. We had previously developed a novel bioinformatics method for marker gene selection and applied this method to gene expression data from STS patients. This previous analysis revealed that the extracted gene combination of macrophage migration inhibitory factor (MIF) and stearoyl-CoA desaturase 1 (SCD1) is an effective diagnostic marker to discriminate between subtypes of STSs with highly different outcomes. In the present study, we hypothesize that the combination of MIF and SCD1 is also a prognostic marker for the overall outcome of STSs. To prove this hypothesis, we first analyzed microarray data from 88 STS patients and their outcomes. Our results show that the survival rates for MIF- and SCD1-positive groups were lower than those for negative groups, and the p values of the log-rank test are 0.0146 and 0.00606, respectively. In addition, survival rates are more significantly different (p = 0.000116) between groups that are double-positive and double-negative for MIF and SCD1. Furthermore, in vitro cell growth inhibition experiments by MIF and SCD1 inhibitors support the hypothesis. These results suggest that the gene set is useful as a prognostic marker associated with tumor progression.

Impact of Margin Status and Local Recurrence on Soft-Tissue Sarcoma Outcomes

The impact of local recurrence and surgical resection margin status on survival in extremity soft-tissue sarcomas remains to be clearly defined. Our aim was to conduct a retrospective analysis of prospectively collected data to determine the prognostic relevance of positive resection margins and local recurrence for extremity soft-tissue sarcomas for survival. Three hundred and sixty-three patients who underwent resection of localized primary extremity soft-tissue sarcomas with curative intent were selected from the United States Department of Defense Automated Central Tumor Registry. Outcomes for local recurrence, distant recurrence, disease-specific survival, and overall survival were analyzed according to clinical, pathological, and treatment variables with use of the Kaplan-Meier method (log-rank test) and the multivariate Cox regression model. Positive margins (hazard ratio, 1.99 [95% confidence interval, 1.15 to 3.45]), local recurrence (hazard ratio, 2.93 [95% confidence interval, 1.38 to 6.23]), and distant recurrence (hazard ratio, 12.13 [95% confidence interval, 5.97 to 24.65]) were significantly associated with overall survival on multivariate Cox regression analysis. However, for disease-specific survival, local recurrence was not significant and tumor size of >10 cm (hazard ratio, 2.83 [95% confidence interval, 1.15 to 6.95]), positive margins (hazard ratio, 1.95 [95% confidence interval, 1.05 to 3.63]), and distant recurrence (hazard ratio, 9.46 [95% confidence interval, 4.37 to 20.47]) were independent adverse prognostic factors. The disease-specific survival rate for patients with localized soft-tissue sarcomas was 89% (95% confidence interval, 85% to 92%) for five years and 75% (95% confidence interval, 70% to 81%) for ten years. Positive surgical margins are consistently associated with adverse survival-related outcomes in localized soft-tissue sarcomas of the extremity. Local recurrence had a significant impact on overall survival, but not on disease-specific survival.

2010 Musculoskeletal Tumor Society: Editorial Comment: Journal-Society Synergy in Scholarly Publication

Clinical Orthopaedics and Related Research (CORR) has a long record of accomplishment in publishing oncologic work. It has published many focused symposia regarding specific topics (eg, bone and cartilage transplantation [Volume 174, 1983]; neurofibromatosis [Volume 245, 1989]; osteosarcoma [Volume 270, 1991]). Since 1999 when CORR became the official organ for the Musculoskeletal Tumor Society (MSTS), the journal has published a symposium of the best selected articles from the annual meeting of the MSTS. The relationship between the journal and the society has promoted the interests of both organizations. The journal gets dependable high-quality content, and the society gets high-quality editing and dissemination of its aggregated best work. Each organization achieved its goals due to this mutually beneficial arrangement. The successful relationship should continue. MSTS, “Who’s your daddy?” It is CORR. CORR is the clarion voice for musculoskeletal oncology. The data speak. CORR publishes more articles with higher citation index than any other journal dealing with musculoskeletal oncology (Table 1). This includes all surgical and orthopaedic specialties. Indeed, CORR publishes more than all the other journals combined when it comes to bone tumors. For example, it dwarfs others in publications regarding osteosarcoma and giant cell tumor, the leading primary malignant and benign conditions that require orthopaedic surgery. Even in the domain of soft tissue sarcoma, orthopaedic surgeons have made the greatest contributions to the surgical literature, and CORR has led the way. CORR is clearly the best international forum for musculoskeletal tumor scholarly work. Table 1 Number of musculoskeletal tumor articles published by leading journals Investigator-initiated research was the basis of the 2010 Musculoskeletal Tumor Society Meeting. Thus, there was no specific focus, but a broad range of topics was covered. The program committee identified the best presentations for inclusion in this symposium. Included are papers dealing with complications of medical, radiation, and surgical treatment, examination of how surgical margin affects recurrence and outcome of soft tissue sarcoma, the management of several different benign and malignant tumors, followup of various reconstructive procedures, and difficulty dealing with certain anatomic sites such as the pelvis. These papers provide a balanced view of modern work done in the field of musculoskeletal oncology. Notably missing, however, was significant work dealing with tumor biology. Perhaps authors present their biologic work at other meetings and submit it to other journals. Hopefully it does not reflect orthopaedic surgeons abjuring biology. Regardless, biology is the inexorable force behind cancer, and the meeting should strive for balance between the biologic and mechanical aspects of oncologic practice. In the long run, the MSTS must focus more on biology if we are to make progress against musculoskeletal cancers. The MSTS, our members, and our patients owe a debt of gratitude to CORR for promoting research and clinical improvement in oncology and disseminating the knowledge internationally (Fig. ​(Fig.11). Fig. 1 Dr. John H. Healey is shown.

Surgical Outcome of Soft Tissue Sarcomas of the Adductor Compartment

To review outcomes and complications of 25 consecutive patients with soft tissue sarcomas in the adductor compartment. Records of 11 men and 14 women aged 20 to 83 (mean, 56) years who underwent resection for soft tissue sarcomas in the adductor compartment were reviewed. Two of the patients had undergone inadequate resection of the tumour elsewhere. No patient had metastases. 20 and 2 patients underwent neo-adjuvant and postoperative radiotherapy, respectively. The interval between radiotherapy and surgery was at least 3 weeks. No neo-adjuvant chemotherapy was given. 24 patients underwent limb salvage surgery and one had external hemipelvectomy. 21 patients had direct wound closure; in 4 a microsurgical free flap was used. The overall survival rate was 81% and 72% at 3 and 5 years, respectively, and remained unchanged until the end of follow-up. Four patients died from pulmonary metastases and one died from liver metastases. One patient had local recurrence, and 7 (26%) developed major complications. Five patients underwent revision surgery. Good survival and local control rates can be achieved in patients with soft tissue sarcomas in the adductor compartment using limb salvage and radiotherapy.

Correction: A Three-Gene Signature for Outcome in Soft Tissue Sarcoma

Correction: A Three-Gene Signature for Outcome in Soft Tissue Sarcoma

A Three-Gene Signature for Outcome in Soft Tissue Sarcoma

Finding markers or gene sets that would further classify patients into different risk categories and thus allow more individually adapted multimodality treatment regimens in soft tissue sarcomas is necessary. In this study, we investigated the prognostic values of hypoxia-inducible factor 1a (HIF1a), heparin-binding epidermal growth factor-like growth factor (HB-EGF), vascular endothelial growth factor (VEGF), and other angiogenesis-related gene expressions, as well as their interrelationships. Formalin-fixed paraffin-embedded tissue samples were obtained from 45 patients with soft tissue sarcoma (median age 57 years, range 16-85 years). After laser capture microdissection direct quantitative real-time reverse transcription-PCR (TaqMan) assays were done in triplicates to determine HIF1a, HB-EGF, VEGF, and other gene expression levels. Multivariate Cox [corrected] regression analysis revealed significant independent associations of HB-EGF, HIF1a, and VEGF-C gene expression to the overall survival (P < 0.0001). A combined factor of these three genes showed a relative risk for shorter survival of 5.5, more than twice higher as in an increasing International Union against Cancer Stage. Receiver operating characteristic curve analysis showed a significant sensitivity of 73% and specificity of 82% of this factor for the diagnosis of short (<3 years) versus long (3-9 years) survival (P = 0.0002). VEGF-A showed significant gender differences in the association to survival. Measuring HIF1a, HB-EGF, and VEGF-C expression may contribute to a better understanding of the prognosis of patients with soft tissue sarcoma and may even play a crucial role for the distribution of patients to multimodal therapeutic regimens. Prospective studies investigating the response to different adjuvant or palliative therapies seem to be warranted.

New medical treatment options and strategies to assess clinical outcome in soft-tissue sarcoma

Soft-tissue sarcomas (STSs) are a heterogeneous group of rare malignant tumors predominantly arising from the embryonic mesoderm. The mainstay of curative therapy is the complete surgical resection of all tumor manifestations with negative histological margins. However, up to 50% of patients will develop distant metastases during the course of their disease. The prognosis for those patients is grim with a 5-year overall survival of less than 10%. First-line systemic therapy with ifosfamide and doxorubicin results in overall response rates of only 20% by conventional response evaluation criteria in solid tumors (RECIST). However, stabilization of disease can be seen in a greater proportion. Therefore, the role of the RECIST criteria has been questioned and the implementation of new imaging studies (e.g., FDG-PET) has shown promising results in assessing early tumor response to therapy. Furthermore, a broader insight into the molecular pathways of sarcomagenesis has been gained in recent years, revealing intriguing targets for new therapeutic approaches (e.g., VEGF, VEGF receptor, IGF receptor, EGF receptor, mTOR and cyclin-dependent kinases). In addition, a growing body of evidence is linking specific genetic aberrations with clinical outcome (e.g., SYT–SXX translocation in synovial sarcoma). With further insight into the biology of STS and the combination of new treatment options with modern imaging techniques, we will most certainly be able to improve clinical outcome in patients with STS in the upcoming years.

Fungating Soft-Tissue Sarcomas

Several variables have been reported as being prognostic with regard to the outcomes of soft-tissue sarcomas. Although the tumors are subjectively ominous, no prior study has been performed to evaluate the treatment or prognosis of fungating soft-tissue sarcomas. We performed a retrospective review of all soft-tissue sarcomas treated at our institution between 1989 and 2004 that had been followed for a minimum of two years or until the death of the patient. Our study group consisted of twenty-four patients with a primary high-grade fungating tumor, and our control group consisted of 146 consecutive patients with a primary high-grade non-fungating tumor. The study cohorts were compared with regard to disease presentation, treatment, and oncologic outcomes. There were no significant differences in tumor size, tumor depth, or histopathologic diagnoses between the cohorts, although the patients with a fungating tumor tended to be older (mean, sixty-five years compared with fifty-five years in the control group; p = 0.004) and have shorter postoperative follow-up (mean, thirty-eight months compared with sixty-five months in the control group; p = 0.03). The proportion of patients presenting with metastases was significantly greater in the group with a fungating tumor (33% compared with 9% in the control group; p = 0.003). Significantly more patients with a fungating tumor underwent amputation (35% compared with 12% in the control group; p = 0.01), while a greater proportion of control patients received radiation therapy (68% compared with 39% in the group with a fungating tumor; p = 0.02). There was no difference in the proportions of patients receiving chemotherapy or in the local recurrence rates between the two cohorts. The Kaplan-Meier five-year overall survival estimates were 20% in the group with a fungating tumor compared with 63% (p < 0.0001) in the control group. The Kaplan-Meier five-year disease-specific survival estimates for patients presenting with localized disease was 58% in the group with a fungating tumor and 74% in the control group (p = 0.05). Multivariate analysis demonstrated that disease stage, fungation, and a tumor size of > or = 10 cm were significant independent negative prognostic factors for disease-specific survival. Malignant tumor ulceration is an independent predictor of a poor prognosis for patients with a high-grade soft-tissue sarcoma. Despite the discouraging overall prognosis, aggressive multidisciplinary treatment can lead to long-term survival in an important subgroup of patients with fungating lesions.

The use of in-vitro drug resistance levels as a predictor of outcome in soft tissue sarcoma

20510 Background: We have assayed in-vitro drug resistance and immunohistochemical staining for drug resistance markers (MDR-1, MRP) in patients with metastatic soft tissue sarcoma patients. We looked at resistance to Cisplatin, Doxorubicin, and Ifosphamide, prior to beginning chemotherapy. The aim of this study was to investigate the validity of in-vitro drug resistance testing as a predictor of outcome. Methods: Viable tumor samples obtained at time of recurrence or metastasis from 13 patients with metastatic soft tissue sarcoma were tested by a semiquantitative 12 hour tritiated-thymidine uptake cell-proliferation assay (EDR test, Oncotech Inc., Tusin, California) for resistance to the chemotherapy drugs cisplatin, doxorubicin, and ifosphamide. The mean drug resistance level for these three drugs was plotted against survival in months, both from time of metastasis and time of initiation of chemotherapy. Mean resistance was also correlated with positive staining for either MDR-1 or MRP. Results: There was no relationship found between the mean drug resistance and survival, either from time of metastasis (correlation coefficient -0.0596) or time of initiation of chemotherapy (correlation coefficient - 0.1864). There was no correlation between mean drug resistance and; 1) presence of MDR-1 staining (correlation coefficient -0.1269), 2) presence of MRP staining (correlation coefficient -0.2175), 3) presence of either staining for MDR-1 or MRP (correlation coefficient -0.2636). Conclusions: 1) In-vitro drug resistance is not predictive of outcome in patients with soft tissue sarcoma. 2) There is no correlation between the mean drug resistance and positive staining for either MDR-1 or MRP. No significant financial relationships to disclose.

Tumor Necrosis Has no Prognostic Value in Neoadjuvant Chemotherapy for Soft Tissue Sarcoma

Neoadjuvant chemotherapy for treatment of soft tissue sarcomas is controversial, and the correlation between local recurrence and survival is unclear. Histologic necrosis is a well-documented predictor of survival in patients with malignant bone tumors; however, the association is unknown in patients with soft tissue sarcomas. We assessed the prognostic significance of tumor necrosis for treatment of soft tissue sarcomas. We retrospectively collected data from 82 patients who received neoadjuvant chemotherapy for treatment of soft tissue sarcomas of the extremities. Patients had wide resections if tumors were high-grade, deep to the investing fascia, and had clear margins. We quantified the amount of necrosis and analyzed the relationship with local recurrence and overall survival. At an average followup of 65 months (range, 24-154 months), the 5-year local recurrence rates for patients with less than 95% and 95% or greater necrosis were 20% and 33%, respectively. The overall 5-year survivorship rates for patients with less than 95% necrosis and 95% or greater necrosis were 82% and 78%, respectively. There was no difference in recurrence-free survival or overall patient survival based on the amount of histologic necrosis. Tissue necrosis from neoadjuvant chemotherapy does not seem to predict outcome in soft tissue sarcomas.

Expression of hypoxia-inducible factor (HIF)-1α as a biomarker of outcome in soft-tissue sarcomas

Hypoxia-inducible factor (HIF)-1alpha is a transcription factor that supports the adaptation of human cancer cells to hypoxia and tumor growth and progression. The overexpression of HIF-1alpha protein has been reported to be associated with a worse prognosis in various cancers. However, the expression of HIF-1alpha in soft-tissue sarcomas has not yet been characterized. The expression of HIF-1alpha protein was immunohistochemically determined in 49 specimens of soft-tissue sarcomas including malignant fibrous histiocytoma (29 patients), synovial sarcoma (12 patients), leiomyosarcoma (four patients), and malignant peripheral nerve sheath tumors (four patients). The 49 samples consisted of 40 primary lesions and nine local recurrences. An immunohistochemical analysis showed the nuclear accumulation of HIF-1alpha protein in 35 (71.4%) samples. The expression of HIF-1alpha was negative in 14 (28.6%) cases, weak in nine (18.4%), moderate in 17 (35.4%), and strong in nine (18.4%). The patients with a strong or moderate expression of HIF-1alpha had a significantly shorter overall survival rate in comparison with those with a weak or negative expression in a univariate analysis (P = 0.029; log-rank test) and multivariate analysis (P = 0.018). This is the first report that demonstrated an overexpression of HIF-1alpha protein to be an independent prognostic factor for soft-tissue sarcomas.

Does the method of treatment affect the outcome in soft-tissue sarcomas of the adductor compartment?

We have investigated the significance of the method of treatment on the oncological and functional outcomes and on the complications in 184 patients with soft-tissue sarcomas of the adductor compartment managed at three international centres. The overall survival at five years was 65% and was related to the grade at diagnosis and the size of the tumour. There was no difference in overall survival between the three centres. There was, however, a significant difference in local control with a rate of 28% in Centre 1 compared with 10% in Centre 2 and 5% in Centre 3. The overall mean functional score using the Toronto Extremity Salvage Score in 70 patients was 77% but was significantly worse in patients with wound complications or high-grade tumours. The scores were not affected by the timing of radiotherapy or the use of muscle flaps. This large series of soft-tissue sarcomas of the adductor compartment has shown that factors influencing survival do not vary across the international boundaries studied, but that methods of treatment affect complications, local recurrence and function.

The Influence of Older Age on Outcome in Soft Tissue Sarcoma of the Extremity

Purpose/Objective: The NIH has identified the relationship between aging and cancer as a subject in urgent need of increased research. Although older age is considered a predictor of poor outcome in soft tissue sarcoma (STS), it remains unclear whether such an outcome could be accounted for by association with other poor prognostic factors, the extent of treatment, or older age per se. The purpose of this study was to attempt to answer these questions in a group of patients with STS of the extremity.

Anatomic location does not impact survival in soft tissue sarcoma of the extremity

9056 Background: Various prognostic factors are known to influence outcome of soft tissue sarcomas. Although anatomic location of extremity sarcoma as a prognostic factor is debatable, several studies suggest lower extremity sarcoma have a worse outcome than upper extremity sarcoma. The aims of the current study were to evaluate overall survival (OS) and disease-free survival (DFS) of soft tissue sarcomas located in the extremity, and test the prognostic value of a series of clinicopathological parameters. Methods: A Retrospective review was undertaken to identify patients with sarcoma located in the extremities. All patients received their primary surgical treatment in our department between January 1991 and December 2001. Univariate and multivariate analyses of potential predictive factors were evaluated with the log-rank test and Cox regression. Results: Of the 134 patients identified, 99 patients had lower extremity sarcoma and 35 patients had upper extremity sarcoma. No differences in size, stage or adjuvant therapy were identified between upper and lower extremity sarcomas (p=.11, p=.22 and p=.24, respectively). Mean age was 50 years. Median follow-up was 27 months (range 1–116 months). By univariate analysis, stage, size, and adjuvant therapy of the primary tumor were associated with a decreased in both OS (p<.05) and DFS (p<.05). Age 50 years or greater influenced OS (p<.001) but not DFS (p=.21). Histology of the primary tumor did not effect OS (p=.21) but tended to effect DFS (p<.001). Anatomic location and gender did not significantly influence OS or DFS. By multivariate Cox regression, only adjuvant therapy effected DFS (p=.002). Age, gender, histology, size, stage, and adjuvant therapy did not significantly influence DFS. Overall-survival was influenced by age, histology, stage, and adjuvant therapy. Anatomic location did not have an effect on OS (p=.17) or DFS (p=.99). Conclusion: Location of the primary site of extremity sarcoma does not influence overall survival and disease-free survival. Patients with upper extremity sarcoma do not have a worse outcome than patients with lower extremity sarcoma. No significant financial relationships to disclose.

Anatomic location does not impact survival in soft tissue sarcoma of the extremity

9056 Background: Various prognostic factors are known to influence outcome of soft tissue sarcomas. Although anatomic location of extremity sarcoma as a prognostic factor is debatable, several studies suggest lower extremity sarcoma have a worse outcome than upper extremity sarcoma. The aims of the current study were to evaluate overall survival (OS) and disease-free survival (DFS) of soft tissue sarcomas located in the extremity, and test the prognostic value of a series of clinicopathological parameters. Methods: A Retrospective review was undertaken to identify patients with sarcoma located in the extremities. All patients received their primary surgical treatment in our department between January 1991 and December 2001. Univariate and multivariate analyses of potential predictive factors were evaluated with the log-rank test and Cox regression. Results: Of the 134 patients identified, 99 patients had lower extremity sarcoma and 35 patients had upper extremity sarcoma. No differences in size, stage or adjuvant therapy were identified between upper and lower extremity sarcomas (p=.11, p=.22 and p=.24, respectively). Mean age was 50 years. Median follow-up was 27 months (range 1–116 months). By univariate analysis, stage, size, and adjuvant therapy of the primary tumor were associated with a decreased in both OS (p<.05) and DFS (p<.05). Age 50 years or greater influenced OS (p<.001) but not DFS (p=.21). Histology of the primary tumor did not effect OS (p=.21) but tended to effect DFS (p<.001). Anatomic location and gender did not significantly influence OS or DFS. By multivariate Cox regression, only adjuvant therapy effected DFS (p=.002). Age, gender, histology, size, stage, and adjuvant therapy did not significantly influence DFS. Overall-survival was influenced by age, histology, stage, and adjuvant therapy. Anatomic location did not have an effect on OS (p=.17) or DFS (p=.99). Conclusion: Location of the primary site of extremity sarcoma does not influence overall survival and disease-free survival. Patients with upper extremity sarcoma do not have a worse outcome than patients with lower extremity sarcoma. No significant financial relationships to disclose.

Techniques to modulate radiotherapy toxicity and outcome in soft tissue sarcoma.

Radiotherapy (RT) targeting of soft tissue sarcoma presents considerable opportunity and challenges in realizing the dual goals of tissue and function preservation and maintaining high local control. Traditional RT target volumes used for soft tissue sarcoma have largely been constrained by available technology and are not ideal in some situations. The advent of very precise treatment planning and delivery systems, including three-dimensional conformal radiotherapy and intensity-modulated radiotherapy, means it is possible to select target volumes that more closely approach the optimum. Consequently, these new approaches provide great opportunity for treatment enhancement in the future. It can be expected that newer techniques for RT planning and delivery will challenge the existing dogma concerning target delineation for optimal radiotherapy outcome. It can be foreseen that the precise knowledge of appropriate targets will continue to evolve for different clinical scenarios and likely be greatly influenced by enhanced imaging capability. Advancement of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy over the next decade must rely on the consistent reporting and sharing of results concerning outcome of normal tissue from volumetric treatment planning.

Statistical Classification Strategy for Proton Magnetic ResonanceSpectra of Soft Tissue Sarcoma: An Exploratory Study withPotential Clinical Utility

Purpose: Histological grading is currently one of the best predictors of tumor behavior and outcome in soft tissue sarcoma. However, occasionally there is significant disagreement even among expert pathologists. An alternative method that gives more reliable and non-subjective diagnostic information is needed. The potential use of proton magnetic resonance spectroscopy in combination with an appropriate statistical classification strategy was tested here in differentiating normal mesenchymal tissue from soft tissue sarcoma. Methods: Fifty-four normal and soft tissue sarcoma specimens of various histological types were obtained from 15 patients. One-dimensional proton magnetic resonance spectra were acquired at 360 MHz. Spectral data were analyzed by using both the conventional peak area ratios and a specific statistical classification strategy. Results: The statistical classification strategy gave much better results than the conventional analysis. The overall classification accuracy (based on the histopathology of the MRS specimens) in differentiating normal mesenchymal from soft tissue sarcoma was 93%, with a sensitivity of 100% and specificity of 88%.The results in the test set were 83, 92 and 76%, respectively. Our optimal region selection algorithm identified six spectral regions with discriminating potential, including those assigned to choline, creatine, glutamine, glutamic acid and lipid. Conclusion: Proton magnetic resonance spectroscopy combined with a statistical classification strategy gave good results in differentiating normal mesenchymal tissue from soft tissue sarcoma specimens ex vivo. Such an approach may also differentiate benign tumors from malignant ones and this will be explored in future studies.

Prognostic Relevance of a Histological Grading System Using MIB-1 for Adult Soft-Tissue Sarcoma

Several histological grading systems have been proposed and found as strong indicators of outcome in soft-tissue sarcomas. However, a putative independent prognostic influence of recently developed biological and molecular markers remains to be established. This study investigated the prognostic relevance of a histological grading system based on the assessment of proliferative activity in adult soft-tissue sarcomas of the extremities, trunk, head, and neck. Tissue blocks from 95 of 108 patients without distant metastases or regional lymph node involvement were available. Immunohistochemical staining for MIB-1 and p53 was done on paraffin-embedded sections. All clinicopathologic and immunohistochemical variables and patient survival were assessed using univariate and multivariate analyses. Variables included histological grading based on the modified Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) system using the MIB-1 score for the estimation of the proliferative potential of the tumors. Variables associated with overall survival were tumor site in the trunk, head and neck, mitosis count, necrosis, MIB-1 score, FNCLCC grade, modified FNCLCC grade using the MIB-1 score, and stage (all p values <0.05). In multivariate analysis, the modified grade proved to be the most significant predictor of shortened overall survival, in addition to tumor site in the trunk, head, and neck. Overexpression of p53 did not correlate with increased risk of tumor mortality. Using MIB-1 to replace mitosis counts in the FNCLCC system improves grading of soft-tissue sarcomas, and this in conjunction with other important factors appear to be more accurate prognostic factors for survival, and for patient selection in investigational adjuvant treatment trials.

484 - Association of tumour growth on nude mice and poor outcome in soft tissue sarcoma (STS) patients

484 - Association of tumour growth on nude mice and poor outcome in soft tissue sarcoma (STS) patients

394 Outcome in soft tissue sarcomas of the chest wall

394 Outcome in soft tissue sarcomas of the chest wall