Timing and Frequency of Surveillance After Resection of Extremity and Trunk Soft Tissue Sarcoma: Identifying...

Surveillance practices after resection of extremity and truncal soft-tissue sarcoma (ETSTS) vary, with guidelines recommending physical exam and imaging every 3-6 months. Local and distant recurrence risks differ based on clinicopathological features including tumor grade and histopathologic subtype. The aim of this study was to evaluate surveillance patterns after ETSTS resection at our high-volume sarcoma referral center and determine if opportunities exist to de-escalate intensity of surveillance in appropriate patients.

A retrospective review of patients with primary ETSTS who underwent resection and surveillance at our institution from 2016-2021 was performed. Patients with less than 2 years of follow-up after resection were excluded. Sarculator, a validated nomogram for soft-tissue sarcoma, was used to stratify patients into high- (< 60%) and low-risk (≥ 60%) prognostic groups based on their predicted overall survival (OS) at 10 years.

The cohort of 296 patients included 112 high- and 184 low-risk. 5-year OS was 70.5% in the high-risk group versus 90.9% in the low-risk group (P < 0.001). Most patients did not recur during the study period (n = 206). 26 patients recurred within 6 months from their initial surgery (18 high-risk, 8 low-risk) and all were offered immediate treatment after recurrence diagnosis. Of this cohort, 84.6% were offered immediate treatment after diagnosis of recurrence.

Surveillance strategies after primary resection should be tailored to patient's individual risk. Patients with low-risk clinicopathologic features have a lower chance of recurrence in the first two years and frequent surveillance visits may not impact their oncologic outcomes.