Localised thoracic sarcomas: outcome improvement over time at a single institution

To assess changes in survival over time in patients affected by thoracic soft tissue sarcomas treated at a single institution.

Patients with localised adult-type deep thoracic soft tissue sarcoma surgically treated at our institution between 1980 and 2012 were retrospectively reviewed. Patients were categorised into two groups according to timing of their first operation, i.e. surgery done before or after 31st December 2001 (so called 'early years' and 'recent years' groups, respectively), since a more extended surgery was used in the second interval. Overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastases (DM) were calculated for each time period.

Three-hundred-thirty-seven patients were identified. Median follow-up was 4.7 years. Tumour size and rate of critical site involvement were larger in 'recent years', while the distribution of all other tumour- and patient-related factors was identical in the two periods. Despite this, OS and CCI of LR were significantly better in 'recent years' as compared to 'early' ones, the 5-year OS increasing from 58% to 72% and the CCI of LR dropping from 22% to 11%. CCI of DM was equal in the two periods.

Reference institutions for sarcomas may have improved their outcome in the last years. Although biases of retrospective analyses need to be discounted, it is possible that optimal exploitation of a series of subtle improvements in sarcoma treatment may make a difference in results achievable today.