Factors Influencing Prognosis After Initial Inadequate Excision(IIE) for Soft Tissue Sarcoma

[摘要] Purpose. The influence of initial inadequate excision (IIE) of soft tissue sarcoma (STS) on local control and overall survivalis not well established. It is generally believed that an IIE may have a negative impact on both, despite subsequent treatmentby radical surgery and radiotherapy. However, data on local recurrence-free survival/overall survival are conflicting and thereare no data on the effect of IIE on overall survival.Patients and methods. A retrospective analysis was made of 86 patients with soft tissue sarcoma of the extremities and trunkafter an IIE had been performed due to inappropriate work-up. The minimal follow-up was 7 years. Specimens of thesubsequent radical resection were evaluated for residual tumor, grade of tumor and complications of IIE. Endpoints wererecurrence-free survival and overall survival.Results. Specimens of the subsequent radical resection showed residual tumor in 66 patients (77%). The most commoncomplication after IIE was hematoma. In both univariate and multivariate analyses, grade II/III tumors and complicationsafter IIE are significant negative prognostic factors for local recurrence-free survival (P= 0.008 andP= 0.002, respectively,in the Cox model). For this survival, three prognostic groups could be formed based on grade, or presence or absence ofcomplications. Adjuvant radiotherapy did not change the rate of local recurrence-free survival. For overall survival, onlytumor grade is a significant factor (log-rank test).Conclusion. This retrospective study shows that complications associated with an IIE have a significant negative effect onlocal control, but not on overall survival, because IIE is often the result of inappropriate work-up before surgery. For betterdiagnosis and therapy STS should be treated in specialized centers.

[学科分类] 肿瘤学