Growth Rate and Outcomes in Locally Recurrent Extremity and Truncal Soft Tissue Sarcoma

Area of Science:

• Oncology
• Surgical Oncology
• Sarcoma Research

Background:

• Prognostic tools for locally recurrent extremity or truncal soft tissue sarcoma (STS) require improvement.
• Accurate prediction of outcomes after repeat resection is crucial for patient management.

Purpose of the Study:

• To investigate the association between the average local recurrence (LR) growth rate and patient outcomes following surgical resection of recurrent STS.
• To identify potential prognostic factors for disease-specific death (DSD) and second local recurrence.

Main Methods:

• Retrospective cohort study utilizing a prospectively maintained database from a high-volume US tertiary sarcoma center.
• Included patients aged 16+ who underwent repeat resection of locally recurrent extremity or truncal STS (1982-2021).
• Excluded specific STS subtypes and patients with prior distant recurrence; analyzed average LR growth rate, DSD, and second LR incidence.

Main Results:

• A cohort of 253 patients was analyzed; 5-year DSD cumulative incidence was 29%.
• LR growth rate (HR, 1.12) was independently associated with higher DSD, alongside younger age, R1/R2 margins, high LR grade, and multifocality.
• An optimal LR growth rate cutoff of 0.68 cm/mo identified patients with significantly higher 5-year DSD (63% vs 19%) and amputation rates (19% vs 7%).

Conclusions:

• Average local recurrence growth rate is an independent predictor of disease-specific death in patients with recurrent extremity or truncal STS.
• Patients with LR growth rates exceeding 0.68 cm/mo exhibit poor prognoses, including elevated mortality and amputation risk.
• These findings support considering perioperative systemic therapy for patients with aggressive LR growth rates.