[Prognostic factors in sarcomas of the soft tissues]

The reported 5-year survival rate for patients with soft-tissue sarcomas varies from 40% to 60%. This substantial mortality rate is attributed to the well recognized propensity of soft-tissue sarcomas for both local recurrence and hematogenous dissemination. The main prognostic factors in resectable sarcomas include histologic grade, size and site of primary tumor as well as an adequate surgery. The frequency of local recurrence is highly variable (10% to 60%), depending on the site of primary tumor and the extent of surgery performed. The lungs are the most common site (70-80%) of all metastases. The prognosis for patients with a locally recurrent tumor, which is fully resectable in the absence of metastases, is similar to the prognosis for patients whose tumors are fully resected and have no history of local recurrence. The outcome for patients with recurrent disease depends on the site of recurrence, rather on the site of the primary sarcoma. Current survival data support an aggressive approach to resection of isolated pulmonary metastases. The prognostic value of adjuvant and neoadjuvant (intra-arterial) chemotherapy is not yet fully established. In patients with disseminated disease and treated with chemotherapy, performance status remains the single most important prognostic factor.