What Factors Influence the Outcome of Surgically Treated Soft Tissue Sarcomas of the Hand and Wrist?

Background: Soft tissue sarcomas (STS) of the hand are exceedingly rare. The aim of this study was to review our institution’s experience with STS of the hand to identify factors affecting outcomes and survivorship. Methods: We retrospectively reviewed the records of 46 hand STS treated with definitive surgery at our institution between 1992 and 2013. Pertinent demographics as well as information regarding the surgical procedure, and disease status at latest follow-up were reviewed. Mean age at diagnosis was 38 years with a mean follow-up of 5 years. Results: The most common tumor subtypes were epithelioid (n = 10) and synovial sarcoma (n = 8). Sixty-one percent were superficial in location. Thirty-three patients had had a nononcologic resection prior to definitive surgical treatment at our institution. Ultimately, negative margins were obtained in all cases. Local recurrence was observed in 5 patients and distant metastases in 14 patients. Tumor sizes ≥2 cm, American Joint Committee on Cancer (AJCC) grade, and depth of the tumor were found to adversely affect the outcome in terms of disease-free and overall survival. Reexcision of an inadvertently excised tumor at an outside institution did not adversely affect the outcome. The 10-year overall and disease-free survival was 72% and 63%. Conclusions: Local recurrence after a wide excision was observed infrequently; however, distant disease was relatively common. Tumors with a size ≥2 cm were associated with a worse disease-free and overall survival, highlighting the aggressive nature of these tumors.

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Adjuvant Treatment of High-risk Adult Soft Tissue Sarcomas: A Survey by the Italian Sarcoma Group

Tumori Journal ◽

10.1177/030089160609200202 ◽

2006 ◽

Vol 92 (2) ◽

pp. 92-97 ◽

Cited By ~ 5

Author(s):

Sergio Frustaci ◽

Massimiliano Berretta ◽

Alessandro Comandone ◽

Ettore Bidoli ◽

Antonino De Paoli ◽

...

Keyword(s):

Overall Survival ◽

High Risk ◽

Soft Tissue ◽

Survival Rates ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Free Survival ◽

Disease Free ◽

Overall Survival Rates

Aims and Background After the first adjuvant study on adult soft tissue sarcomas was concluded, the participating institutions continued to select and treat patients according to that protocol. The aim of this study was to test the protocol reproducibility when applied as a standard practice. Methods A call for retrospective data was launched in June 1999 (self-referral of consecutive unregistered patients); thereafter, a prospective follow-up was performed. The treatment regimen consisted of epirubicin (60 mg/m2 days 1 and 2), ifosfamide (3 g/m2/die for 3 days) and equimolar doses of 6-mercapto-ethansulfonate (MESNA), with 300 μg G-CSF administered subcutaneously from day +8 until recovery, every 3 weeks for a total of 5 cycles. Results From November 1996 to June 1999, 55 high-risk, adult patients were treated. The average median dose intensity was 89% of the planned program. Grade 3-4 toxicities were leukopenia (49%), thrombocytopenia (14%), transfusion requiring anemia in 7 patients (16%), and alopecia in all patients (100%). After a median follow-up of 70 months, 23 patients (41.8%) relapsed and 19 died. Median disease-free, local disease-free and overall survival rates have not yet been reached. The disease-free survival rates at 2 and 4 years were 73% and 57%, respectively; the corresponding overall survival rates were 91% and 70%, respectively. Conclusions The feasibility and reproducibility of the original protocol were confirmed, since disease-specific overall survival and disease-free survival rates at the same period of observation and with the same prolonged follow-up did not differ.

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TP1.2.3Oncological Outcomes of Organ Preservation Strategies - Local Excision Procedures and ‘Watchful Waiting’ In Management of Low Rectal Cancers – A Systematic Review And Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab362.002 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

A R Aspari ◽

V Ramesh ◽

G Kumar ◽

S N Narayanasamy ◽

A O Gumber ◽

...

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Local Recurrence ◽

Organ Preservation ◽

Meta Analysis ◽

Disease Free Survival ◽

Distant Metastases ◽

Free Survival ◽

Rectal Cancers ◽

Disease Free

Abstract Objective To evaluate local recurrence, metastases, and survival outcomes of `wait and watch’ (WW) strategy and local excision (LE) of tumours, in comparison to the present standard practice of total mesorectal excision (TME) for locally advanced rectal cancers. Data Sources MEDLINE, EMBASE, PubMed databases, and sources of Grey literature. Study Selection Randomised and non-randomised prospective studies, retrospective studies with propensity-score-matched analyses. Data Extraction and Synthesis These were carried out independently by two reviewers. A random-effects methodology was used for meta-analyses. Data was presented keeping with the 27-item PRISMA checklist. Main Outcomes The primary outcomes of interest were local recurrence, distant metastases, disease-free-survival and overall-survival, which were assessed in comparison to those associated with radical surgeries (TME). Results 7 of the 16 studies in the systematic review were included for the quantitative synthesis and meta-analysis. Local recurrence rates were comparable amongst patients in WW group and LE group to those undergoing TME. [Risk ratio (RR) 3.07/1.41; 95% Confidence Interval (CI) 0.86-10.95/0.66-3.01; P = 0.08/P=0.89 respectively]. Rates of distant metastases in the WW group and LE group were comparable to those undergoing TME [RR = 0.71/0.94; 95% CI 0.22-2.30/0.55-1.61; P = 0.56/ P = 0.83 respectively]. The median 3-year disease-free survival among patients undergoing WW, LE procedure, and TME were 88%, 80%, and 78.2% respectively; and the median 3-year overall survival among the three groups were 96%, 93%, and 89.5% respectively. Conclusions and Relevance Organ-preservation strategies appear to be a viable treatment option in the management of rectal-cancers. Further research is warranted to provide stronger levels of evidence on organ-preservation strategies.

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Adjuvant chemotherapy for patients with high-grade soft-tissue sarcomas of the extremity.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.9.1491 ◽

1988 ◽

Vol 6 (9) ◽

pp. 1491-1500 ◽

Cited By ~ 127

Author(s):

A E Chang ◽

T Kinsella ◽

E Glatstein ◽

A R Baker ◽

W F Sindelar ◽

...

Keyword(s):

Overall Survival ◽

Adjuvant Chemotherapy ◽

Dose Regimen ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

High Dose ◽

Free Survival ◽

High Dose Regimen ◽

Disease Free

We have previously reported the results of a randomized trial that demonstrated the survival benefit of adjuvant chemotherapy in the treatment of patients with high-grade extremity sarcomas compared with no chemotherapy. This regimen included doxorubicin, cyclophosphamide, and methotrexate. This report updates and extends our experience. The median follow-up of this trial is now 7.1 years and reveals a 5-year disease-free survival of 75% and 54% for chemotherapy and no chemotherapy groups, respectively (two-sided P [P2] = .037). The 5-year overall survival for patients in this trial was 83% and 60% for the chemotherapy and no chemotherapy groups, respectively, with a trend towards improved survival in the chemotherapy arm (P2 = .124). Because of doxorubicin-induced cardiomyopathy we performed a subsequent randomized trial comparing this high-dose regimen to reduced cumulative doses of doxorubicin and cyclophosphamide without methotrexate. Eighty-eight patients were entered into this trial which has a median follow-up of 4.4 years. The 5-year disease-free and overall survival for patients treated with the reduced doses of chemotherapy was 72% and 75%, respectively, and was not significantly different from the high-dose regimen. No patients developed congestive heart failure on this study. We conclude that adjuvant chemotherapy improves disease-free survival in patients with extremity soft-tissue sarcomas. The overall survival advantage in patients receiving adjuvant chemotherapy in our initial randomized high-dose chemotherapy trial has diminished though it continues to favor the chemotherapy group. A reduced-dose chemotherapy regimen was found to be comparable to the high-dose regimen.

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Radiomic features for patients with primary soft tissue sarcomas: A prognostic study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e23532 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e23532-e23532

Author(s):

Sandro Pasquali ◽

Marco Bologna ◽

Gabriele Infante ◽

Raffaella Vigorito ◽

Antonella Messina ◽

...

Keyword(s):

Soft Tissue ◽

Ct Scan ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Distant Metastases ◽

Myxoid Liposarcoma ◽

Added Value ◽

Discriminative Ability ◽

End Point

e23532 Background: Prognosis of extremity soft tissue sarcomas (ESTS) and retroperitoneal sarcomas (RPS) is currently estimated on clinical-pathological features, as those incorporated in the Sarculator nomogram. This study investigated the added value of end-point specific radiomic signatures (RS) in patients with primary ESTS and RPS. Methods: We retrospectively analysed data from patients with a ESTS (N = 100) or a RPS (N = 116) who underwent surgery (Jan2011-Dec2015) at one sarcoma reference institute and had magnetic resonance imaging (MRI) or computed tomography (CT) scan, respectively. Radiomic features were extracted from DICOM files of MRI and CT scan for ESTS and RPS, respectively. The study end-points were incidence of distant metastases (DM) and overall survival (OS) for ESTS and disease-free survival (DFS) and OS for RPS. A RS was established for each end-point. Models discriminative ability was measured using the Harrell c-index (C). Results: ESTS histology was undifferentiated pleomorphic sarcoma, myxofibrosarcoma, myxoid liposarcoma, dedifferentiated/pleomorphic liposarcoma, and others in 28, 21, 18, 9, and 24 patients, respectively. At a median follow-up of 61 months, the 5-yr DM-free rate and OS were 73.6% (95%CI 64.2-82.2%) and 73.4% (95%CI 64.5-83.6), respectively. A prognostic model based on the Sarculator and a DM-RS achieved higher C (0.86, 95%CI 0.77-0.93) than the Sarculator alone (0.83, 95%CI 0.71-0.94). For OS, the RS was not able to increase the Sarculator discriminative ability (Sarculator and OS-RS: C = 0.73, 95%CI 0.62-0.82; Sarculator alone: C = 0.72, 95%CI 0.62-0.81). RPS histology was well differentiated liposarcoma, dedifferentiated liposarcoma, leiomyosarcoma, and other in 22 (19%), 60 (52%), 22 (19%), and 12 (10%) patients, respectively. At a median follow-up of 58 months, 5-yr DFS and OS were 46.7% (95%CI, 37.8-57.6%) and 68% (95% CI 59.9-79.0%), respectively. RS extracted from CT scan without contrast enhancement slightly improve the discriminative ability of the Sarculator for DFS (Sarculator and DFS-RS: C = 0.65, 95%CI 0.57-0-72; Sarculator alone: C = 0.63, 95%CI 0.55-0.70) but not for OS (0.70, 95%CI 0.60-0.80 and 0.69, 95%CI 0.59-0.79, respectively). Conclusions: RS did not improve the discriminative ability of the Sarculator for OS. The added value for RS in relapse prediction (DM incidence for ESTS and DFS for RPS) deserves further investigations.

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Outcome Prediction in Primary Resected Retroperitoneal Soft Tissue Sarcoma: Histology-Specific Overall Survival and Disease-Free Survival Nomograms Built on Major Sarcoma Center Data Sets

Journal of Clinical Oncology ◽

10.1200/jco.2012.44.3747 ◽

2013 ◽

Vol 31 (13) ◽

pp. 1649-1655 ◽

Cited By ~ 165

Author(s):

Alessandro Gronchi ◽

Rosalba Miceli ◽

Elizabeth Shurell ◽

Fritz C. Eilber ◽

Frederick R. Eilber ◽

...

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Cox Model ◽

External Validation ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Histologic Subtype ◽

Free Survival ◽

Quality Of Surgery ◽

Disease Free

Purpose Integration of numerous prognostic variables not included in the conventional staging of retroperitoneal soft tissue sarcomas (RPS) is essential in providing effective treatment. The purpose of this study was to build a specific nomogram for predicting postoperative overall survival (OS) and disease-free survival (DFS) in patients with primary RPS. Patients and Methods Data registered in three institutional prospective sarcoma databases were used. We included patients with primary localized RPS resected between 1999 and 2009. Univariate (Kaplan and Meier plots) and multivariate (Cox model) analyses were carried out. The a priori chosen prognostic covariates were age, tumor size, grade, histologic subtype, multifocality, quality of surgery, and radiation therapy. External validation was performed by applying the nomograms to the patients of an external cohort. The model's discriminative ability was estimated by means of the bootstrap-corrected Harrell C statistic. Results In all, 523 patients were identified at the three institutions (developing set). At a median follow-up of 45 months (interquartile range, 22 to 72 months), 171 deaths were recorded. Five- and 7-year OS rates were 56.8% (95% CI, 51.4% to 62.6%) and 46.7% (95% CI, 39.9% to 54.6%. Two hundred twenty-one patients had disease recurrence. Five- and 7-year DFS rates were 39.4% (95% CI, 34.5% to 45.0%) and 35.7% (95% CI, 30.3% to 42.1%). The validation set consisted of 135 patients who were identified at the fourth institution for external validation. The bootstrap-corrected Harrell C statistics for OS and DFS were 0.74 and 0.71 in the developing set and 0.68 and 0.69 in the validating set. Conclusion These nomograms accurately predict OS and DFS. They should be used for patient counseling in clinical practice and stratification in clinical trials.

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Monoclonal antibody therapy for resected Dukes' C colorectal cancer: seven-year outcome of a multicenter randomized trial.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.5.1788 ◽

1998 ◽

Vol 16 (5) ◽

pp. 1788-1794 ◽

Cited By ~ 338

Author(s):

G Riethmüller ◽

E Holz ◽

G Schlimok ◽

W Schmiegel ◽

R Raab ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Disease Free Survival ◽

Distant Metastases ◽

Proportional Hazard ◽

Antibody Treatment ◽

Wide Range ◽

Disease Free ◽

Dukes C

PURPOSE As previously shown, antibody treatment increased survival of patients with resected colorectal cancer of stage Dukes' C. Since the 5-year analysis was criticized because of the wide range (2.7 to 7.5 years) of follow-up time, we performed a 7-year analysis with only four of 189 patients monitored for less than 5 years. PATIENTS AND METHODS A total of 189 patients with resected Dukes' C colorectal cancer were randomly allocated to infusions of a total of 900 mg 17-1A antibody, 500 mg postoperatively followed by 4 monthly doses of 100 mg (n=99), or to observation only (n=90). Primary end points were overall survival and disease-free interval. Patients were stratified by a dynamic randomization according to center, sex, location of tumor, number of affected lymph nodes, and preoperative carcinoembryonic antigen concentration. RESULTS Randomization produced balanced distribution of risk factors. After 7 years of follow-up evaluation, treatment had reduced overall mortality by 32% (Cox's proportional hazard, P < .01; log-rank, P=.01) and decreased the recurrence rate by 23% (Cox's proportional hazard, P < .04; log-rank, P=.07). The intention-to-treat analysis gave a significant effect for overall survival (Cox's proportional hazard, P < .01; log-rank, P=.02) and disease-free survival (Cox's proportional hazard, P=.02; log-rank, P=.11 ). While distant metastases were significantly reduced (Cox's proportional hazard, P=.004; log-rank, P=.004), local relapses were not (Cox's proportional hazard, P=.65; log-rank, P=.52). This differential effect of 17-1A antibody on disseminated isolated tumor cells versus occult local satellites may explain the increased significance seen in the overall survival. CONCLUSION The now-matured study shows that 17-1A antibody administered after surgery prevents the development of distant metastasis in approximately one third of patients. The therapeutic effect is maintained after 7 years of follow-up evaluation.

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Retrospective Analysis of Clinicopathologic and Management Aspects of Soft Tissue Sarcoma

QJM ◽

10.1093/qjmed/hcaa057.010 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

T H Kamel ◽

A M Adel ◽

R M Faheim ◽

R Hegazy

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Progression Free Survival ◽

Disease Status ◽

Free Survival ◽

Factors Affecting ◽

The Mean ◽

Highly Correlated ◽

Prognostic And Predictive Factors

Abstract Background Soft tissue sarcomas (STS) are a group of rare aggressive tumors of mesenchymal origin, separated into over 50 different subtypes by histological and molecular classifications, In this analysis we evaluated the clinicopathologic and management aspects of STS. We analyzed the prognostic and predictive factors affecting both OS & PFS. Patients and Methods Medical records of 92 patients with STS were reviewed retrospectively. Overall survival (OS) and progression free survival (PFS) were estimated and factors potentially influencing these outcomes were analyzed. Results The mean age of patients was 45 +- 15.95 years (range 16-84 years). Median OS was 35.6 +_ 5.2 months and median PFS was 10.2 months. Age was assessed as a predictive factor for OS and patients <50 years had higher median OS (42.3 months) compared to patients >50 years’ old who had median OS (13.2 months) with no statically significance (P = 0.069). Also patients ≤50 years had median PFS (12.1 months’ vs 10.1 months) in patients ≥ 50 years with no statistically significance on PFS type. Type of pathology was also highly significantly correlated to overall survival (P = 0.000), liposarcoma had improved OS (42.3 months) compared to other histopathological subtypes. However, it showed no statistically significance to PFS (P = 0.036) with higher median PFS in liposarcoma (22.3 months) compared to other histopathological subtypes. Conclusion Mean age was found to be 45.9 +- 15 years old, with type of pathology. Histopathological subtypes and disease status were assessed as predictive and prognostic factor and were found to be highly correlated to OS. Effect of RTH on OS and PFS is well noted

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What Factors Are Predictive of Outcome in the Treatment of Soft Tissue Sarcomas of the Foot and Ankle?

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000113 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Taylor Beahrs ◽

Norman Turner ◽

Cody Wyles

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Tumor Size ◽

Soft Tissue Sarcomas ◽

Published Data ◽

Maximal Dimension ◽

Foot And Ankle ◽

Increased Risk

Category: Tumor Introduction/Purpose: Soft tissue sarcomas (STS) of the foot and ankle are common, accounting for 10% of sarcomas; however, there exists little published data on the outcome of treatment. Because of the unique anatomy of the foot and ankle, and the fact that benign lesions in this area are 200-fold more common than malignant lesions, these tumors can be frequently misdiagnosed, leading to unplanned excision and poor outcomes. The purpose of this study was to describe outcomes of the surgical treatment of STS of the foot and ankle at our institution, with an analysis on risk factors for local and distant recurrence, as well as overall survival. Methods: We reviewed the records of 62 foot and ankle soft tissue sarcomas treated with definitive surgery at our institution between 1992 and 2013. The cohort consisted of 35 males and 27 females with a mean age at diagnosis of 45 years and a mean follow-up of 7 years. Age, gender, anatomic location, tumor size, subtype, stage, neoadjuvant and adjuvant treatments, previous surgery, surgical procedure, and disease status at latest follow-up was recorded. Results: The most common tumor subtype was synovial sarcoma (n = 16). The overall limb salvage rate was 53%. Local recurrence was observed in 9 patients and distant metastases in 15 patients. Tumor size >=3 cm in maximal dimension was the greatest risk factor in mortality. Post treatment complications occurred in 15 patients. Local recurrence and development of distant disease was relatively common following wide excision of a soft tissue sarcoma of the foot and ankle. Tumors that were >=3 cm in maximal dimension were associated with a worse overall survival and patients with neoadjuvant radiation were at increased risk of complications. Conclusion: The results of our study highlight the aggressive nature of soft tissue sarcomas of the foot and ankle, with smaller tumors than previously reported (<5 cm) behaving like high-grade advanced disease.

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Surgical Management of Retroperitoneal Soft Tissue Sarcomas: Role of Curative Resection

The American Surgeon ◽

10.1177/000313481608200215 ◽

2016 ◽

Vol 82 (2) ◽

pp. 128-133

Author(s):

Fausto Rosa ◽

Claudio Fiorillo ◽

Antonio Pio Tortorelli ◽

Alejandro Martin SÁNchez ◽

Guido Costamagna ◽

...

Keyword(s):

Soft Tissue ◽

Surgical Management ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Tumor Grade ◽

Term Survival ◽

Free Survival ◽

Factors Affecting ◽

Retroperitoneal Sarcomas ◽

Disease Free

Retroperitoneal sarcomas are a rare group of malignant soft tissue tumors with a generally poor prognosis. However, factors affecting the recurrence and long-term survival are not well understood. The aim of this study was to assess clinical, pathological, and treatment-related factors affecting prognosis in patients with retroperitoneal sarcomas. The hospital records of 107 patients who underwent surgical exploration at our unit for primary or recurrent retroperitoneal sarcomas between 1984 and 2013 were reviewed. Of these patients, 92 had a primary tumor and 15 had a recurrent neoplasm. Study end points included factors affecting overall and recurrence-free survival for the 92 patients with primary disease. Mean follow-up was 79.7 ± 56.3 months. Only the patients undergoing surgery for primary sarcoma were included in this study. Overall 5-year survival was 71 per cent. Disease-free 5-year survival was 65 per cent. Only tumor grade affects overall and disease-free survival. This study confirmed the importance of an aggressive surgical management for retroperitoneal sarcomas to offer these patients the best chance of cure. In our series, only the tumor grade seems to be associated with worse outcome and higher rate of recurrence, regardless of the size of the tumor.

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The Correlation of Surgical Margins and Outcome Of Soft Tissue Sarcomas of The Extremities and Trunk in Hospital Sultan Ismail, Johor Bahru

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i1.918 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Muhamad Firdaus bin Zainudin

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Survival Rates ◽

Soft Tissue Sarcomas ◽

Surgical Margin ◽

Study Patient ◽

P Value ◽

Limb Salvage Surgery

Introduction: Patients with soft tissue sarcoma are treated following the standardized guidelines, however it is not guaranteed patient will remain free from local recurrence (LR) and metastasis. This study was conducted to determine the association between microscopic marginal status with local recurrence, metastasis and the survival of the patient. Materials and Methods: This retrospective study was conducted from January 2015 to December 2017 in Hospital Sultan Ismail, Johor Bahru. All patients underwent complete standadized resection of the tumour and had been follow up for 5 years. An operating and follow-up records of 70 cases who fulfill the inclusion and exclusion criteria were collected and analysed using Pearson chi square test and Kaplan-Meier curves. Results: Of the 70 patients, 52 were males and 18 were females. The age of the patients were between 16 and 73 years with the means age of 48.8 years old. Sixty eight patients underwent limb salvage surgery and 2 had amputation. 42 of them had positive post-operative microscopic surgical margin (PMSM) while 28 were negative. Local recurrence was noted in 28 and metastasis in 30 patients. Patient who had PMSM has higher risk to get local recurrence and metastasis compared to patient with negative margin (p-value <0.001). The overall median survival was 23 months. Overall survival rates for 3 years was 80% and for 5 years was 65%. Conclusion: In our study, patient with positive post-operative microscopic surgical margin had higher possibility to develop local recurrence, metastases and decrease overall survival rate.

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