Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma: Analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy

Purpose: The objective of this study was to define whether survival of patients with extremity soft tissue sarcoma (STS), stratified for known risk factors, has improved over the last 20 years. Patients and Methods: From January 1982 to December 2001, 1,706 patients with primary and recurrent STS of the extremities were treated at our institution and were prospectively followed. From this cohort, we selected 1,261 patients who underwent complete macroscopic resection and had one of the following histopathologies: fibrosarcoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, or synovial sarcoma. Median follow-up was 55 months. Patient, tumor, and treatment factors were analyzed as prognostic factors. Results: The 5-year disease-specific actuarial survival was 79% (78% for patients treated from 1982 to 1986, 79% for patients treated from 1986 to 1991, 79% for patients treated from 1992 to 1996, and 85% for patients treated from 1997 to 2001; P = not significant). For high-risk patients (high-grade, > 10 cm, deep tumors; n = 247), 5-year disease-specific survival was 51% (50% for patients treated from 1982 to 1986, 45% for patients treated from 1986 to 1991, 52% for patients treated from 1992 to 1996, and 61% for patients treated from 1997 to 2001; P = not significant). Tumor depth, size, grade, microscopic margin status, patient age, presentation status (primary tumor versus local recurrence), location (proximal versus distal), and certain histopathologic subtypes were significant prognostic factors for disease-specific survival on multivariate analysis; however, time period of treatment was not. Conclusion: Prognosis of patients with extremity STS, stratified for known risk factors, has not improved over the last 20 years, indicating that current therapy has reached the limits of efficacy.

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18F-FLT PET/CT as a prognostic imaging biomarker of disease specific survival in patients with primary soft tissue sarcoma

Journal of Nuclear Medicine ◽

10.2967/jnumed.121.262502 ◽

2021 ◽

pp. jnumed.121.262502

Author(s):

Joseph Crompton ◽

Wesley R. Armstrong ◽

Mark A. Eckardt ◽

Ameen Seyedroudbari ◽

William D. Tap ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Imaging Biomarker ◽

Disease Specific Survival ◽

Flt Pet ◽

Pet Ct ◽

Disease Specific

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Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.5.1679 ◽

1996 ◽

Vol 14 (5) ◽

pp. 1679-1689 ◽

Cited By ~ 860

Author(s):

P W Pisters ◽

D H Leung ◽

J Woodruff ◽

W Shi ◽

M F Brennan

Keyword(s):

Prognostic Factors ◽

Soft Tissue ◽

Local Recurrence ◽

Tumor Size ◽

Recurrent Disease ◽

Soft Tissue Sarcomas ◽

Distant Recurrence ◽

Disease Specific Survival ◽

Positive Surgical Margins ◽

Disease Specific

PURPOSE To identify specific independent adverse clinicopathologic factors for event-free survival in a cohort of consecutively treated patients with extremity soft tissue sarcomas. PATIENTS AND METHODS Prospectively collected data from a population of 1,041 adult patients with localized (American Joint Committee on Cancer [AJCC] stage IA to IIIB) extremity soft tissue sarcomas were analyzed. Patients were treated at a single institution between 1982 and 1994. Patient, tumor, and pathologic factors were analyzed by univariate and multivariate techniques to identify independent prognostic factors for the end points of local recurrence, distant recurrence, disease-specific survival, and post-metastasis survival. RESULTS The 5-year survival rate for this cohort of patients was 76%, with a median follow-up time of 3.95 years. Significant independent adverse prognostic factors for local recurrence were age greater than 50 years, recurrent disease at presentation, microscopically positive surgical margins, and the histologic subtypes fibrosarcoma and malignant peripheral-nerve tumor. For distant recurrence, intermediate tumor size, high histologic grade, deep location, recurrent disease at presentation, leiomyosarcoma, and nonliposarcoma histology were independent adverse prognostic factors. For disease-specific survival, large tumor size, high grade, deep location, recurrent disease at presentation, the histologic subtypes leiomyosarcoma and malignant peripheral-nerve tumor, microscopically positive surgical margins, and lower extremity site were adverse factors. For post-metastasis survival, only large tumor size ( > 10 cm) was an adverse prognostic factor. CONCLUSION The independent adverse prognostic factors for distant recurrence and disease specific survival differ from those identified for subsequent local recurrence. Patients with microscopically positive surgical margins or patients who present with locally recurrent disease are at increased risk for subsequent local recurrence and tumor-related mortality. Specific histopathologic subtypes are associated with increased risks for local failure and tumor-related mortality.

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Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.3.859 ◽

1996 ◽

Vol 14 (3) ◽

pp. 859-868 ◽

Cited By ~ 676

Author(s):

P W Pisters ◽

L B Harrison ◽

D H Leung ◽

J M Woodruff ◽

E S Casper ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Control ◽

Distant Metastasis ◽

Soft Tissue Sarcomas ◽

Complete Resection ◽

High Grade ◽

Disease Specific Survival ◽

Recurrence Rates ◽

Disease Specific

PURPOSE This trial was performed to evaluate the impact of adjuvant brachytherapy on local and systemic recurrence rates in patients with soft tissue sarcoma. PATIENTS AND METHODS In a single-institution prospective randomized trial, 164 patients were randomized intraoperatively to receive either adjuvant brachytherapy (BRT) or no further therapy (no BRT) after complete resection of soft tissue sarcomas of the extremity or superficial trunk. The adjuvant radiation was administered by iridium-192 implant, which delivered 42 to 45 Gy over 4 to 6 days. The two study groups had comparable distributions of patient and tumor factors, including age, sex, tumor site, tumor size, and histologic type and grade. RESULTS With a median follow-up time of 76 months, the 5-year actuarial local control rates were 82% and 69% in the BRT and no BRT groups (P = .04), respectively. Patients with high-grade lesions had local control rates of 89% (BRT) and 66% (no BRT) (P = .0025). BRT had no impact on local control in patients with low-grade lesions (P = .49). The 5-year freedom-from-distant-recurrence rates were 83% and 76% in the BRT and no BRT groups (P = .60), respectively. Analysis by histologic grade did not demonstrate an impact of BRT on the development of distant metastasis, despite the improvement in local control noted in patients with high-grade lesions. The 5-year disease-specific survival rates for the BRT and no BRT groups were 84% and 81% (P = .65), respectively, with no impact of BRT regardless of tumor grade. CONCLUSION Adjuvant brachytherapy improves local control after complete resection of soft tissue sarcomas. This improvement in local control is limited to patients with high-grade histopathology. The reduction in local recurrence in patients with high-grade lesions is not associated with a significant reduction in distant metastasis or improvement in disease-specific survival.

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Follow-up after primary treatment of soft tissue sarcoma of extremities: Impact of frequency of follow-up imaging on disease-specific survival

Journal of Surgical Oncology ◽

10.1002/jso.23060 ◽

2012 ◽

Vol 106 (2) ◽

pp. 155-161 ◽

Cited By ~ 14

Author(s):

Yi-Sheng Chou ◽

Chun-Yu Liu ◽

Wei-Ming Chen ◽

Tain-Hsiung Chen ◽

Paul Chih-Hsueh Chen ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Primary Treatment ◽

Disease Specific Survival ◽

Disease Specific

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Association of local recurrence with subsequent survival in extremity soft tissue sarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.2.646 ◽

1997 ◽

Vol 15 (2) ◽

pp. 646-652 ◽

Cited By ~ 176

Author(s):

J J Lewis ◽

D Leung ◽

M Heslin ◽

J M Woodruff ◽

M F Brennan

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcoma ◽

Distant Metastasis ◽

High Grade ◽

Disease Specific Survival ◽

Primary Tumors ◽

Poor Prognostic Factor ◽

Extremity Soft Tissue Sarcoma ◽

Disease Specific

PURPOSE The aim of this study was to analyze local recurrence in a large cohort of prospectively followed patients with primary extremity soft tissue sarcoma. In particular, we analyzed the correlation of local recurrence with subsequent metastasis and disease-specific survival. PATIENTS AND METHODS Patients who underwent treatment for primary extremity soft tissue sarcoma from July 1982 through July 1995 at Memorial Sloan-Kettering Cancer Center were the subject of this study. Local recurrence, distant metastasis, and disease-specific survival were used as end points of the study. The influence of local recurrence on subsequent distant metastasis and disease-specific survival were examined using the Cox proportional hazards model. RESULTS We treated 911 patients, of whom 297 (33%) developed recurrent disease. Local recurrence occurred in 116 patients (13%), metastasis in 167 (18%), and synchronous local recurrence and metastasis in 13 (2%). Of 116 patients who developed local recurrence, 38 subsequently developed metastasis and 34 died of disease. Metastasis after local recurrence was predicted in patients with initial high-grade (P = .005; risk = 3.5) or deep (P = .02; risk = 2.9) tumors. Tumor mortality after local recurrence was predicted in patients with initial high-grade (P = .007; risk = 3.7) or large (> 5 cm; P = .01; risk = 3.2) primary tumors. DISCUSSION These findings suggest that there is a strong association of local recurrence with the development of subsequent metastasis and tumor mortality, and that local recurrence is a poor prognostic factor. It would seem prudent to consider patients who develop local recurrence and have high-grade tumors as being at high risk for systemic disease and therefore eligible for investigational adjuvant systemic therapy.

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The value of C-reactive protein as an independent prognostic indicator for disease-specific survival in patients with soft tissue sarcoma: A meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0219215 ◽

2019 ◽

Vol 14 (7) ◽

pp. e0219215 ◽

Cited By ~ 6

Author(s):

Xiaolin Wang ◽

Song Liu ◽

Xiaoli Zhao ◽

Erhu Fang ◽

Xiang Zhao

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Meta Analysis ◽

Prognostic Indicator ◽

Disease Specific Survival ◽

C Reactive Protein ◽

Reactive Protein ◽

Disease Specific

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Soft Tissue Sarcoma

10.2310/surg.2042 ◽

2020 ◽

Author(s):

Aimee M. Crago ◽

Samuel Singer

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Tumor Staging ◽

Treatment Algorithm ◽

Tumor Location ◽

Disease Specific Survival ◽

Cross Sectional ◽

Clinical Prognosis ◽

Histologic Subtype ◽

Disease Specific

Soft tissue sarcoma (STS) refers to a rare group of cancers that develop from mesenchymal cells and their progenitors. Histologic subtype, in conjunction with tumor location and size, largely defines the biologic behavior of a given lesion and the associated clinical prognosis in these cancers. The diverse characteristics of these tumors means that their treatment is similarly complex. The etiology, tumor staging and prognosis, evaluation, and treatment of STS are discussed in this review, with an aim to present an algorithm for patient evaluation and treatment while highlighting common indications for diverging from this strategy as dictated by disease subtype and location. Figures show the histologic distribution of primary STS diagnosed in the extremity and retroperitoneum and intra-abdominal compartments; disease-specific survival for primary extremity and retroperitoneal and intra-abdominal tumors stratified by histologic subtype; local recurrence in primary extremity STS stratified by histologic subtype; disease-specific survival according to American Joint Committee on Cancer (AJCC) TNGM stage; a postoperative nomogram for prediction of sarcoma-specific death at 12 years postresection for patients with STS; representative cross-sectional images of an atypical lipomatous tumor, a myxofibrosarcoma, and a desmoid tumor; a treatment algorithm for STS of the extremity; a magnetic resonance image and intraoperative photographs showing a mixoid liposarcoma of the posterior thigh; and computed tomography showing a retroperitoneal dedifferentiated liposarcoma and a photograph of the surgical bed following resection. This review contains 10 figures, 12 tables, and 49 references. Keywords: Sarcoma, soft tissue, cancer, myxofibrosarcoma, leiomyosarcoma, liposarcoma, gastrointestinal stromal tumor, rhabdomyosarcoma,

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