Orthopedic Surgical Management of Soft Tissue Sarcomas in a Referral Center: 5-Year Oncological Outcomes

Soft tissue sarcomas (STS) are malignant tumors of connective tissue, characterized by a wide heterogeneity in their presentations, resulting in variable therapeutic strategies between reference centers. However, clinical outcomes from an orthopedic and trauma surgery department of university hospitals are poorly documented. We evaluated the 5-year local recurrence rate of patients managed according to our local strategy and operated in our department, which is certified for the management of both soft tissues and bone sarcomas. We also assessed overall survival, metastasis and reoperation rates, as well as risk factors associated with these events.

Our hypothesis was that our results were relatively similar to those from other reference centers.

We analyzed 466 cases of STS of the limbs and trunk operated on between 2012 and 2019. The median patient age was 57 years, including 259 men (56%). Among them, 351 tumors (75%) were treatment-naïve; 18 patients (4%) had lymph node involvement, and 33 patients (7%) presented with metastases at initial management. There were 315 sarcomas larger than 5 cm (72%). Sarcomas were located deep in 385 cases (83%) and in the proximal lower limb in 352 cases (76%). A total of 216 sarcomas (52%) were grade 3. The most frequent histologic subtypes were undifferentiated pleomorphic sarcoma (n = 104, 22%), myxofibrosarcoma (n = 82, 18%), synovial sarcoma (n = 45, 10%), and myxoid and/or round cell liposarcoma (n = 42, 9%). Regarding treatments, 414 patients (89%) underwent limb-sparing surgery, 261 (56%) received radiotherapy, and 138 (30%) received chemotherapy.

At 5 years of follow-up, the local recurrence rate was 14% (95% confidence interval [CI] = 10-18%). Independent risk factors were non-naïve presentation (hazard ratio [HR] = 1.80, 95% CI = 1.04-3.11, p = 0.037), superficial tumor location (HR = 2.14, 95% CI = 1.20-3.83, p = 0.01), grade 3 histology (HR = 1.86, 95% CI = 1.22-2.83, p = 0.004), positive surgical margins (HR = 2.47, 95% CI = 1.44-4.24, p = 0.001), and administration of chemotherapy (HR = 0.51, 95% CI = 0.30-0.87, p = 0.014). Overall survival was 60% (95% CI = 55-66%). The incidence of metastases was 28% (95% CI = 23-33%), and the rate of reoperations was 40% (95% CI = 36-45%).

In our university orthopedic and trauma surgery department, the oncological outcomes were comparable to those reported in the literature from other specialized centers, whether with exclusively oncologic activity or not.

IV; retrospective study.