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The influence of anatomic location on outcome in patients with soft tissue sarcoma of the extremity
Author(s) -
Gerrand Craig H.,
Bell Robert S.,
Wunder Jay S.,
Kandel Rita A.,
O'Sullivan Brian,
Catton Charles N.,
Griffin Anthony M.,
Davis Aileen M.
Publication year - 2003
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.11076
Subject(s) - medicine , sarcoma , soft tissue sarcoma , soft tissue , radiation therapy , surgery , univariate analysis , metastasis , proportional hazards model , multivariate analysis , presentation (obstetrics) , radiology , cancer , pathology
BACKGROUND The anatomic location of an extremity soft tissue sarcoma may influence the patient's presentation, management, and local and systemic recurrence rates. The objective of this study was to compare the presentation, management, and outcome of patients with soft tissue sarcomas of the upper extremity and the lower extremity. METHODS Prospectively collected data from patients who underwent limb‐sparing surgery for extremity soft tissue sarcoma between January, 1986 and April, 1997 were analyzed. Local recurrence free rates and metastasis free rates were calculated using the method of Kaplan and Meier. Univariate and multivariate analyses of potential predictive factors were evaluated with the log‐rank test and the Cox proportional hazards model. RESULTS Of 480 eligible patients, 48 patients (10.0%) had a local recurrence, and 131 patients (27.3%) developed distant metastasis. The median follow‐up of survivors was 4.8 years (range, 0.1–12.9 years). Patients with upper extremity tumors had smaller lesions (6.0 cm vs. 9.3 cm; P < 0.001), more often underwent unplanned excision before referral (89 patients [64.0%] vs. 160 patients [46.9%]; P < 0.001), and less often received radiotherapy (98 patients [70.5%] vs. 289 patients [84.8%]; P < 0.001). The 5‐year local recurrence free rate was 82% for patients with sarcomas of the upper extremity and 93% for patients with sarcomas of the lower extremity ( P = 0.002). The 5‐year metastasis free rate was 82% for patients with sarcomas of the upper extremity and 69% for patients with sarcomas of the lower extremity ( P = 0.013). CONCLUSIONS Local recurrence was more frequent in patients who had sarcomas of the upper extremity compared with patients who had sarcomas of the lower extremity. Factors that contributed to this difference included histologic type, the use of radiotherapy, and local anatomy. Metastasis was more frequent among patients with sarcomas of the lower extremity, because those tumors tended to be large and deeper compared with upper extremity tumors. Cancer 2003;97:485–92. © 2003 American Cancer Society. DOI 10.1002/cncr.11076