Sarcoma in Iran

To review the clinical characteristics of 1470 sarcoma cases and to define the factors in patients that predict out come, relapse and survival.

Retrospective analysis of the database for the period 1991-2002, focusing on demographic, tumor related and treatment related variables, relapse free survival (RFS) and overall survival (OS) using the Kaplan- Meier method. Statistical significance was evaluated using the chi square and t- tests for univariate influence and a Cox regression model for multivariate influence.

Mean age was 30 years. The male to female ratio was 3/2 and 23% of the cases were under 16 years of age. Median tumor diameter was 10.5 centimeters. The bone to soft tissue sarcoma ratio was 3/1 in children and 1/3 in adults. Osteosarcoma, Ewing's tumours and rhabdomyosarcomas accounted for 83% of childhood tumors. In adults osteosarcomas, synovial sarcomas and malignant fibrous histocytomas (MFHs) were the most common subtypes. Mean follow up time was 56 months. Of the total, 25% had initial metastasis, 86% received chemotherapy and 41 % underwent radiotherapy. The main prognostic factors for survival were tumor size, margin of surgery, neurovascular involvement in the pathological report, initial metastasis and no complete response to first therapy. Adjuvant radiotherapy, small tumor size, curative surgery with chemotherapy and free surgical margins were significantly associated with reduced recurrence.

Our patients are characterised by diagnosis with a large tumor size, advanced stage of disease and short survival. A complete response to primary therapy is the main independent variable for overall survival. Earlier diagnosis and an experienced team including surgical, medical and radiotherapy oncologists are needed for a better response and longer survival of patients.