Paratesticular Sarcoma: Analysis of Oncological Outcomes and Prognostic Factors

Paratesticular sarcomas are a rare subtype of genitourinary sarcoma. Incomplete excision results in high recurrence rates. The aim of this study was to report oncological outcomes following surgery and characterize risk factors associated with poor survival.

Paratesticular sarcomas managed at a tertiary sarcoma referral center were identified. Kaplan-Meier survival curves were calculated for local recurrence-free survival (LRFS), metastasis-free survival (MFS) and disease-specific survival (DSS). Univariate analysis was used to identify predictive factors for these outcomes.

A total of 56 cases were identified between 2002 and 2023. The median age at tumor resection was 63 years. Dedifferentiated liposarcoma (DDLPS) was the most common histological subtype with n = 23 (42%) patients. Of the 51 patients with localized disease at presentation, 9 (18%) developed local recurrence, 10 (20%) developed metastatic disease and 10 (20%) have died from the disease at a median follow up of 48 months (IQR 16-93). The 5-year LRFS, MFS and DSS rate was 54.4%, 60.8% and 90.8% respectively. Positive surgical margin was significantly associated with reduced LRFS (HR 3.92, P = .005). T3 stage was associated with reduced LRFS (HR 5.78, P = .022). Tumor Grade 3 was significantly associated with reduced DSS (HR 12.0, P = .038). Patients who underwent wide re-resection (WRR) due to suboptimal primary resection had equivalent LRFS (P = .5) and DSS (P = .75) compared to patients who did not require WRR.

Positive surgical margin status is the single most important parameter for locoregional treatment failure. In these cases, wide re-resection including hemiscrotectomy is required to achieve negative surgical margins. With better awareness, prompt referral to a specialist center which provides a multidisciplinary approach will ensure individualized treatment, risk stratification and optimal oncological outcomes.