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

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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Localized Extremity Soft Tissue Sarcoma: Improved Knowledge With Unchanged Survival Over Time

Journal of Clinical Oncology ◽

10.1200/jco.2003.02.026 ◽

2003 ◽

Vol 21 (14) ◽

pp. 2719-2725 ◽

Cited By ~ 213

Author(s):

Jürgen Weitz ◽

Christina R. Antonescu ◽

Murray F. Brennan

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Current Therapy ◽

Disease Specific Survival ◽

Actuarial Survival ◽

Extremity Soft Tissue Sarcoma ◽

Risk Patients ◽

Disease Specific

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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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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