Do surgical margin and local recurrence influence survival in soft tissue sarcomas?

Area of Science:

• Oncology
• Surgical Pathology
• Cancer Research

Background:

• Prognostic factors for soft tissue sarcomas (STS) include tumor stage, grade, size, depth, and site.
• The impact of positive surgical margins and local recurrence on overall survival in STS remains debated.
• Microscopic margins are critical in surgical oncology for predicting patient outcomes.

Purpose of the Study:

• To investigate the influence of microscopic surgical margins on local recurrence, metastasis, and overall survival in extremity STS.
• To determine if local recurrence independently affects overall survival in these patients.

Main Methods:

• Retrospective review of 248 patients with extremity STS treated surgically (1995-2008).
• Analysis of survival, local recurrence, and distant metastasis rates.
• Evaluation of factors influencing outcomes with a median follow-up of 4.4 years.

Main Results:

• The 5-year cumulative incidence of local recurrence was 4.1%.
• Positive margins or margins ≤2 mm were associated with significantly worse 5-year survival (47%) compared to wider margins (70-72%).
• Local recurrence, metastasis, high grade, high AJCC stage, increasing age, and male gender independently predicted decreased overall survival.

Conclusions:

• Microscopic surgical margin status is a significant predictor of decreased overall survival in intermediate- to high-grade extremity STS.
• Local recurrence following surgical treatment is an independent risk factor for reduced overall survival.
• Inclusion of microscopic margin and local recurrence in risk assessments is recommended for STS management.