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. 2021 Feb;123(2):479-488.
doi: 10.1002/jso.26275. Epub 2020 Nov 4.

Impact of resection margin on outcomes in high-grade soft tissue sarcomas of the extremity-A USSC analysis

Konstantinos Chouliaras  1 , Nathan Patel  1 , Rebecca Senehi  1 , Cecilia G Ethun  2 , George Poultsides  3 , Valerie Grignol  4 , Thomas Clark Gamblin  5 , Kevin K Roggin  6 , Ryan C Fields  7 , Ralph D'Agostino Jr  8 , Edward A Levine  1 , Kenneth Cardona  2 , Konstantinos Votanopoulos  1
Affiliations

Impact of resection margin on outcomes in high-grade soft tissue sarcomas of the extremity-A USSC analysis

Konstantinos Chouliaras et al. J Surg Oncol. 2021 Feb.

Abstract

Background: The optimal margin of resection for high-grade extremity sarcomas and its impact on survival has long been questioned in the setting of adjuvant radiotherapy. The objective of this study was to investigate the impact of resection status on recurrence and survival.

Methods: All patients with primary, nonmetastatic, high-grade extremity sarcomas that underwent surgical resection from January 2000 to April 2016 in the U.S. Sarcoma Collaborative (USSC) were retrospectively reviewed. Recurrence patterns, recurrence-free survival (RFS), and overall survival (OS) were examined in multivariate analyses (MVA).

Results: A cohort of 959 patients was identified with a median follow-up of 34.7 months from diagnosis. R0 resection was achieved in 86.7% (831) while R1 resection in 13.3% (128). Locoregional recurrence for R0 and R1 groups occurred in 9.1% (76) versus 14.8% (19; p = .05) while distant recurrence occurred in 24.7% (205) versus 26.6% (34; p = .65), respectively. Median RFS was 171.2 versus 48.5 (p = .01) while median OS was 149.8 versus 71.5 months (p = .02) for the R0 versus R1 group, respectively. On MVA, female gender (hazard ratio [HR] = 0.69, p = .007) and adjuvant radiotherapy (0.7, p = .04) were associated with improved OS, whereas older age (HR = 1.03, p < .001) and tumor size (HR = 1.01, p < .001) were associated with worse OS. R0 resection status was associated with improved locoregional RFS (HR = 0.56, p = .03) but not with distant RFS (HR = 0.84, p = .4) or OS (HR = 0.7, p = .052).

Conclusions: In high-grade extremity sarcomas, tumor size and gender are predictive of OS while R0 resection status is associated with improved locoregional recurrence rate without a significant impact on distant RFS or OS.

Keywords: R resection status; high-grade extremity sarcomas; negative margins; predictors of recurrence.

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Conflict of interest statement

CONFLICT OF INTERESTS

Nathan Patel has stock/interest in Genomenon Inc. The other authors declare that there are no conflict of interests.

Figures

FIGURE 1
FIGURE 1
Recurrence-free survival Kaplan–Meier curves for the R0 versus R1 groups (log-rank, p = .01)
FIGURE 2
FIGURE 2
Locoregional recurrence-free survival Kaplan–Meier curves for the R0 versus R1 groups (log-rank, p = .005)
FIGURE 3
FIGURE 3
Distant recurrence-free survival Kaplan–Meier curves for the R0 versus R1 groups (log-rank, p = .23)
FIGURE 4
FIGURE 4
Overall survival Kaplan–Meier curves for the R0 versus R1 groups (Log-rank, p = .02)
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References

    1. von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2018;16(5):536–563. - PubMed
    1. Shiu MH, Castro EB, Hajdu SI, Fortner JG. Surgical treatment of 297 soft tissue sarcomas of the lower extremity. Ann Surg. 1975;182(5):597–602. - PMC - PubMed
    1. Abbas JS, Holyoke ED, Moore R, Karakousis CP. The surgical treatment and outcome of soft-tissue sarcoma. Arch Surg. 1981;116(6):765–769. - PubMed
    1. Lindberg RD, Martin RG, Romsdahl MM, Barkley HT. Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer. 1981;47(10):2391–2397. - PubMed
    1. Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305–315. - PMC - PubMed