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. 2016 Jun;5(6):980-8.
doi: 10.1002/cam4.615. Epub 2016 Mar 1.

Outcomes of unplanned sarcoma excision: impact of residual disease

Chris Charoenlap  1   2 , Jungo Imanishi  1 , Takaaki Tanaka  1 , John Slavin  3 , Samuel Y Ngan  4   5 , Sarat Chander  4   5 , Michelle Maree Dowsey  1   6 , Chatar Goyal  1 , Peter F M Choong  1   5   6
Affiliations

Outcomes of unplanned sarcoma excision: impact of residual disease

Chris Charoenlap et al. Cancer Med. 2016 Jun.

Abstract

This study aimed to compare the oncological results between unplanned excision (UE) and planned excision (PE) of malignant soft tissue tumor and to examine the impact of residual tumor (ReT) after UE. Nonmetastatic soft tissue sarcomas surgically treated in 1996-2012 were included in this study. Disease-specific survival (DSS), metastasis-free survival (MFS), and local-recurrence-free survival (LRFS) were stratified according to the tumor location and American Joint Committee on Cancer Classification 7th edition stage. Independent prognostic parameters were identified by Cox proportional hazard models. Two-hundred and ninety PEs and 161 UEs were identified. Significant difference in oncological outcome was observed only for LRFS probability of retroperitoneal sarcomas (5-year LRFS: 33.0% [UE] vs. 71.0% [PE], P = 0.018). Among the 142 UEs of extremity and trunk, ReT in re-excision specimen were found in 75 cases (53%). UEs with ReT had significantly lower survival probabilities and a higher amputation rate than UEs without ReT (5-year DSS: 68.8% vs. 92%, P < 0.001; MFS: 56.1% vs. 90.9%, P < 0.001; LRFS: 75.8% vs. 98.4%, P = <0.001; amputation rate 18.5% vs. 1.8%, P = 0.003). The presence of ReT was an independent poor prognostic predictor for DSS, MFS, and LRFS with hazard ratios of 2.02 (95% confidence interval (CI), 1.25-3.26), 1.62 (95% CI, 1.05-2.51) and 1.94 (95% CI, 1.05-3.59), respectively. Soft tissue sarcomas should be treated in specialized centers and UE should be avoided because of its detrimental effect especially when ReT remains after UE.

Keywords: Neoplasm staging; prognosis; residual neoplasm; sarcoma mortality; sarcoma surgery; soft tissue sarcoma; treatment outcome.

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Figures

Figure 1
Figure 1
Flow diagram of patients included in this study.
Figure 2
Figure 2
(A) Disease‐specific survival and (B) local‐recurrence‐free survival of planned excision (PE) and unplanned excision (UE) of extremity and trunk sarcoma.
Figure 3
Figure 3
(A) Disease‐specific survival and (B) local‐recurrence‐free survival of unplanned excision with residual tumor (ReT (+)) and without residual tumor (ReT (−)) in extremity and trunk sarcoma.
See this image and copyright information in PMC

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