scholarly journals The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Yao Liang ◽  
Tian-Hui Guo ◽  
Bu-Shu Xu ◽  
Dong-Chun Hong ◽  
Hai-Bo Qiu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Residual Disease ◽  
R0 Resection ◽  
Free Survival ◽  
Unplanned Excision ◽  
The Impact

BackgroundUnplanned excision (UPE) of soft tissue sarcoma (STS) is often chosen in the early phase by general physicians without any radiological evaluation.PurposeThe present study aimed to evaluate the impact of UPE on the clinical outcomes of patients with STS of the trunk and extremity.Materials and MethodsPatients with STS of the trunk and extremity who underwent R0 resection between 1998 and 2016 were included and divided into the UPE and planned excision (PE) groups. Propensity score matching (PSM) was used to control the selection bias. The endpoints were disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS).ResultsIn total, 458 patients (277 males, 181 females; median age: 43 years) were included: 329 (71.8%) in the PE group and 129 (28.2%) in the UPE group. The follow-up time ranged from 7.1 to 313.78 months, with a median of 112.18 months. UPE patients were more likely to have a smaller or superficial lesion and were more frequently administered adjuvant therapy. After PSM, compared with the PE group, the UPE group had a longer LRFS (P=0.015), but there was no difference between the two groups regarding DSS and MFS. Residual disease was observed in 77.5% of the re-resected specimens in the UPE group and was a risk factor for DSS (P = 0.046) and MFS (P = 0.029) but was not associated with local recurrence (LR) (P=0.475) or LRFS (P=0.334). Moreover, we found no difference in DSS, LRFS or MFS according to the interval from UPE to definitive resection.ConclusionSTS treated with UPE had distinct characteristics. Patients who undergo UPE followed by an additional wide R0 resection have similar oncological survival compared to patients who undergo an initial PE, although the high incidence of residual tumor in the UPE group leads to an unfavorable clinical course.

A comparison of clinical outcomes between additional excision after unplanned and planned excisions in patients with soft-tissue sarcoma of the limb

2021 ◽  
Vol 103-B (12) ◽  
pp. 1809-1814
Author(s):  
Tomoki Nakamura ◽  
Akira Kawai ◽  
Tomohito Hagi ◽  
Kunihiro Asanuma ◽  
Akihiro Sudo
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Dermatofibrosarcoma Protuberans ◽  
Free Survival ◽  
Unplanned Excision ◽  
Improved Outcomes ◽  
Significant Difference ◽  
Well Differentiated

Aims Patients with soft-tissue sarcoma (STS) who undergo unplanned excision (UE) are reported to have worse outcomes than those who undergo planned excision (PE). However, others have reported that patients who undergo UE may have similar or improved outcomes. These discrepancies are likely to be due to differences in characteristics between the two groups of patients. The aim of the study is to compare patients who underwent UE and PE using propensity score matching, by analyzing data from the Japanese Bone and Soft Tissue Tumor (BSTT) registry. Methods Data from 2006 to 2016 was obtained from the BSTT registry. Only patients with STS of the limb were included in the study. Patients with distant metastasis at the initial presentation and patients with dermatofibrosarcoma protuberans and well-differentiated liposarcoma were excluded from the study. Results A total of 4,483 patients with STS of the limb were identified before propensity score matching. There were 355 patients who underwent UE and 4,128 patients who underwent PE. The five-year disease-specific survival (DSS) rate was significantly better in the patients who received additional excision after UE than in those who underwent PE. There was no significant difference in local recurrence-free survival (LRFS) between the two groups. After propensity score matching, a new cohort of 355 patients was created for both PE and UE groups, in which baseline covariates were appropriately balanced. Reconstruction after tumour excision was frequently performed in patients who underwent additional excision after UE. There were no significant differences in DSS and LRFS between the patients who underwent PE and those who had an additional excision after UE. Conclusion Using propensity score matching, patients with STS of the limb who underwent additional excision after UE did not experience higher mortality and local failure than those who underwent PE. Reconstruction may be necessary when additional excision is performed. Cite this article: Bone Joint J 2021;103-B(12):1809–1814.

scholarly journals Histologic Response Following Pre-Operative Radiotherapy for Soft Tissue Sarcoma (STS) in a French Reference Center and Review

2020 ◽  
pp. 1-8
Author(s):  
Sunyach Marie ◽  
Severine Prapan ◽  
Aurelie Bertaut ◽  
Marie Karanian ◽  
Gualter Vaz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Tumor Cells ◽  
Distant Recurrence ◽  
Recurrence Free Survival ◽  
Histologic Response ◽  
Free Survival ◽  
Viable Cells ◽  
Viable Tumor

Background and Purpose: Limb sparing surgery and radiotherapy is the main treatment of patients harboring soft tissue sarcoma of the extremity. There is limited data regarding the prognostic impact of histologic response after pre-operative radiotherapy. Patients and Methods: Between 2010 and 2018, 123 patients were treated with a pre-operative radiotherapy for soft tissue sarcoma at Leon Berard Centre (Lyon, France) and were retrospectively reviewed. All patients received a dose of 50 Gy in 25 fractions. The histologic response has been analysed by considering the following factors: necrosis ≥ 90%, percentage of viable tumor cells ≤ 10% and fibrosis ≥ 10%. Overall survival (OS), local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS) and event-free survival (EFS) were evaluated. Results: Median follow up was 33.2 months (range 2.3-128.1 months). Local recurrence occurred in 9 patients (7.5%) and 40 patients (33%) presented a distant recurrence. The 2 and 5-year OS was 84% and 63%. Histologic response factors (necrosis ≥ 90%, viable tumor cells ≤ 10% and fibrosis ≥ 10%) were not predictive in DRFS and EFS. In multivariate analysis, grade was the only significant prognostic factor for EFS P=0.0087. Among the 14 patients with ≤ 10% viable cells after irradiation 13 presented a metastatic evolution within 6 months. Conclusion: This study showed that current histological response evaluation based on necrosis, fibrosis and viable cells could not predict clinical outcomes after radiotherapy for extremity soft tissue sarcoma. A significant proportion of patients with a good response after pre-operative radiotherapy present a metastatic recurrence.

scholarly journals Resection vs. ablation for lesions characterized as resectable-ablative within the colorectal liver oligometastases criteria: a propensity score matching from retrospective study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8398
Author(s):  
Ma Luo ◽  
Si-Liang Chen ◽  
Jiawen Chen ◽  
Huzheng Yan ◽  
Zhenkang Qiu ◽  
...  
Keyword(s):  
High Risk ◽  
Propensity Score ◽  
Liver Metastases ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Rank Test ◽  
R0 Resection ◽  
Free Survival ◽  
Resection Group ◽  
Complete Ablation

Background There has been no prospective or retrospective studies reporting the comparison outcome between surgery and ablation for resectable-ablative (lesions could be treated by resection or complete ablation) colorectal liver oligometastases (CLOM). The purpose of this study was to compare the efficacy and prognostic difference in patients who underwent R0 resection vs. complete ablation within the resectable-ablative CLOM criteria. Methods From January 2008 to May 2018, a total of 2,367 patients diagnosed with colorectal liver metastases were included in this observational study. The metastasis was characterized by only limited to liver with number ≤5, size ≤5 cm, and resectable-ablative (lesions could be treated by resection or complete ablation). The evaluated indications, including liver progression-free survival (LPFS), overall survival (OS), survival rates, pattern and number of recurrences, and complications, were compared by using propensity score matching (PSM). The Kaplan−Meier curves were generated, and a log-rank test was performed. The Cox regression model was used for univariate and multivariate analyses to identify predictors of outcomes. Results A total of 421 consecutive patients were eligible for this study, with 250 and 171 undergoing R0 resection and complete ablation, respectively. PSM identified 145 patients from each group. The 1-, 3-, 5- and 8-year OS rates in the resection group and the ablation group were 95.8% vs. 95.0%, 69.8% vs. 60.1%, 53.6% vs. 42.5%, and 45.1% vs. 32.9% (p = 0.075), respectively. The median LPFS in the resection group was significantly longer than that in the ablation group (35 months vs. 15 months, p = 0.011). No statistical difference was found in LPFS between the two groups when comparing ≤3 cm liver metastases. For liver metastasis >3 cm, the median LPFS in the resection group and ablation group was 11 months and 5 months, respectively (p = 0.001). In terms of high risk of clinical risk score (CRS), the resection group showed longer LPFS than the ablation group (median 18 months vs. 10 months, p = 0.043). Conclusion For patients within the CLOM criteria suggesting that liver metastases were resectable as well as ablative, resection could result in longer liver recurrence-free survival than ablation in cases with size >3 cm or high risk of CRS. But for ≤3 cm liver metastases, their treatment efficacies were comparable.

Impact of Smoking History on Pulmonary Metastasis-free Survival in Patients With Soft-tissue Sarcoma

2021 ◽  
Vol 1 (2) ◽  
pp. 89-94
Author(s):  
MASATAKE MATSUOKA ◽  
MASANORI OKAMOTO ◽  
TAMOTSU SOMA ◽  
ISAO YOKOTA ◽  
RYUTA ARAI ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Confidence Interval ◽  
Pulmonary Metastasis ◽  
Hazard Ratio ◽  
Smoking History ◽  
Free Survival ◽  
The Impact

Background/Aim: Although smoking history is predictive of poor pulmonary metastasis-free survival (PMFS) in patients with epithelial tumors, the impact of smoking history on PMFS in those with soft-tissue sarcoma (STS) is not known. Patients and Methods: Patients undergoing treatment for STS at our institutes between 2008 and 2017 were enrolled. Patients were excluded if they had metastatic lesion, or had a histopathological classification demonstrating small round-cell sarcoma. The impact of smoking history on PMFS and overall survival was examined with multivariate analysis using a Cox proportional hazards model. Results: A total of 250 patients were retrospectively reviewed. Patients with smoking history had worse PMFS on multivariate analysis (hazard ratio=2.00, 95% confidence interval=1.12-3.60). On the other hand, smoking history did not significantly affect overall survival (hazard ratio=1.26, 95% confidence interval=0.61-2.58). Conclusion: Patients with STS need to be followed-up by frequent clinical assessments if they have a smoking history.

Unplanned excision of soft tissue sarcoma: The impact of the referring hospital

2013 ◽  
Vol 22 (2) ◽  
pp. e17-e22 ◽  
Author(s):  
Seungcheol Kang ◽  
Ilkyu Han ◽  
Sang A Lee ◽  
Hwan Seong Cho ◽  
Han-Soo Kim
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Unplanned Excision ◽  
The Impact

scholarly journals Oncological outcome and prognostic factors in the therapy of soft tissue sarcoma of the extremities

2012 ◽  
Vol 4 (4) ◽  
pp. 34 ◽  
Author(s):  
Ingmar Ipach ◽  
Tobias Wingert ◽  
Beate Kunze ◽  
Torsten Kluba
Keyword(s):  
Prognostic Factors ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Survival Time ◽  
Cancer Center ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Free Survival ◽  
Therapeutic Concepts

Uniform conclusions about therapeutic concepts and survival time of bone and soft tissue sarcoma patients are difficult due to the heterogeneity of histological subtypes as well as the different responses to neoadjuvant therapy. The subject of this retrospective study was the analysis of tumour free survival, risk and prognostic factors of sarcoma patients treated by limb sparing techniques or amputation. We included 118 patients with soft tissue sarcoma of the extremities treated primarily or secondarily at our institution between 1990 and 2008 with a minimum follow-up of 12 months. Data about the tumour free survival time, operative techniques and potential prognostic factors were analysed. The tumour-specific and overall survival were significantly influenced by two factors: the grading and distant metastases present at time of diagnosis. Optimal multimodal therapeutic concepts at a specialized Cancer Center decreased the risk of local recurrence. The importance of optimal preoperative and surgical course concerning the oncological long term outcome was investigated. The decrease in local recurrence as a result of multimodal therapeutic concepts at a specialized Cancer Center was confirmed. To evaluate the individual prognosis of a patient, multiple factors have to be considered. Factors for a poor prognosis are primary metastasis, high-grade tumours and several histological entities (<em>e.g</em>. synovial sarcoma, not other specified).

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

Sarcoma ◽  
2003 ◽  
Vol 7 (3-4) ◽  
pp. 159-165 ◽  
Author(s):  
Albert N. Van Geel ◽  
Alexander M. M. Eggermont ◽  
Patrick E. J. Hanssens ◽  
Paul I. M. Schmitz
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Tumor Grade ◽  
Residual Tumor ◽  
Radical Resection ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Local Recurrence Free Survival

Purpose. The influence of initial inadequate excision (IIE) of soft tissue sarcoma (STS) on local control and overall survival is not well established. It is generally believed that an IIE may have a negative impact on both, despite subsequent treatment by radical surgery and radiotherapy. However, data on local recurrence-free survival/overall survival are conflicting and there are 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 trunk after an IIE had been performed due to inappropriate work-up. The minimal follow-up was 7 years. Specimens of the subsequent radical resection were evaluated for residual tumor, grade of tumor and complications of IIE. Endpoints were recurrence-free survival and overall survival.Results. Specimens of the subsequent radical resection showed residual tumor in 66 patients (77%). The most common complication after IIE was hematoma. In both univariate and multivariate analyses, grade II/III tumors and complications after 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 of complications. Adjuvant radiotherapy did not change the rate of local recurrence-free survival. For overall survival, only tumor grade is a significant factor (log-rank test).Conclusion. This retrospective study shows that complications associated with an IIE have a significant negative effect on local control, but not on overall survival, because IIE is often the result of inappropriate work-up before surgery. For better diagnosis and therapy STS should be treated in specialized centers.

Limb preserving surgery for soft-tissue sarcoma in the hand: a retrospective study of 51 cases

2020 ◽  
Vol 45 (6) ◽  
pp. 629-635 ◽  
Author(s):  
Mehran Dadras ◽  
Hans-Ulrich Steinau ◽  
Ole Goertz ◽  
Marcus Lehnhardt ◽  
Björn Behr ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Tumour Size ◽  
Long Term Results ◽  
Resection Margins ◽  
Incomplete Resection ◽  
Free Survival

Our retrospective study analysed the long-term results of a conservative limb-preserving surgical strategy in 51 patients with soft-tissue sarcoma of the hand from a single institution. We assessed survival and prognostic factors, including the surgical margins. No transradial amputations were performed. Microscopically free resection margins were obtained in 45 of the patients. The remaining six patients had microscopically incomplete resection. Forty-four surviving patients had a median follow-up of 6.5 years (range 12–307), and one patient had no follow-up beyond 3 months following surgery. Among those patients, 29 had more than 5 years of follow-up. Five-year local-recurrence-free survival was 65%, metastasis-free survival was 84%, and disease-specific survival was 91%. Tumour size was predictive of all outcome parameters, but positive resection margins adversely affected local recurrence only. Survival was similar to the survival after a more radical surgical approach reported in the literature. Level of evidence: IV

scholarly journals Efficacy of hyperthermic isolated limb perfusion in the treatment of locally recurrent high-grade soft tissue sarcoma of the extremities

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Farhad Farzaliyev ◽  
Alexander Touma ◽  
Georg Taeger ◽  
Hans-Ulrich Steinau ◽  
Jendrik Hardes ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Isolated Limb Perfusion ◽  
High Grade ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Limb Perfusion ◽  
Locally Recurrent ◽  
Local Recurrence Free Survival

Abstract Background This novel study compared the use of tumor necrosis factor (TNF)-alpha and melphalan-based isolated limb perfusion (TM-ILP) to the standard treatment of locally recurrent soft tissue extremity sarcoma. The aim was to assess whether TM-ILP positively influences the recurrence-free survival of locally recurrent high-grade soft tissue sarcoma (STS) of the extremities. Methods We retrospectively analyzed our clinical database for patients with STS. Variables were analyzed using chi-square test or Mann-Whitney rank-sum test. Furthermore, Kaplan-Meier survival plots were calculated and a proportional hazard regression model was developed. Results Out of 448 patients with extraabdominal STS treated between August 2012 and December 2015, 52 cases involving 47 patients had locally recurrent STS. Twenty-eight of these patients were treated with TM-ILP prior to surgical resection (TM-ILP-group), and 24 were treated with standard therapy (without TM-ILP). The 3-year recurrence-free survival for the TM-ILP-group was estimated at 75% (95% confidence interval (CI), 71.5–78.5). Local recurrence-free survival in the standard group was significantly lower (LRFS: 43.4%, 95% CI 38.7–48.1, p = 0.026). Multivariable analysis revealed resection with negative margins, lower number of previous recurrences, and TM-ILP as positive predictors for recurrence-free survival. Conclusions TM-ILP and consecutive resection of residual tumor with negative resection margins significantly improves local recurrence-free survival for patients with a first local recurrence of high-grade STS in the extremities.

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