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The effect of the setting of a positive surgical margin in soft tissue sarcoma
Author(s) -
O'Donnell Patrick W.,
Griffin Anthony M.,
Eward William C.,
Sternheim Amir,
Catton Charles N.,
Chung Peter W.,
O'Sullivan Brian,
Ferguson Peter C.,
Wunder Jay S.
Publication year - 2014
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.28793
Subject(s) - medicine , soft tissue sarcoma , context (archaeology) , sarcoma , soft tissue , surgery , surgical margin , margin (machine learning) , resection margin , dissection (medical) , overall survival , resection , pathology , paleontology , machine learning , computer science , biology
BACKGROUND The objectives of this study were to evaluate the risk of local recurrence and survival after soft tissue sarcoma (STS) resection with positive margins and to evaluate the safety of sparing adjacent critical structures. METHODS One hundred sixty‐nine patients with localized STS who had positive resection margins were identified from a prospective database. Patients who had positive margins were stratified into 3 groups, each representing a specific clinical scenario: critical structure positive margin (eg major nerve, vessel, or bone), tumor bed resection positive margin, and unexpected positive margin. The rates of local recurrence‐free survival (LRFS) and cause‐specific survival (CSS) were calculated and compared with relevant control patients who had negative margins after STS resection. RESULTS After planned close dissection to preserve critical structures, the 5‐year LRFS and CSS rates both depended on the quality of the surgical margins (97% and 80.3%, respectively, for those with negative margins vs 85.4% and 59.4%, respectively, for those with positive margins; P = .015 and P = .05, respectively). Negative margins achieved through resection of critical structures because of tumor invasion or encasement only slightly improved the 5‐year rates of LRFS (91.2%) and CSS (63.6%; P = .8 and P = .9, respectively). The lowest 5‐year LRFS and CSS rates were 63.4% and 59.2%, respectively, after an unexpected positive margin during primary surgery. CONCLUSIONS After patients undergo resection of STS with positive margins, oncologic outcomes can be predicted based on the clinical context. Sparing adjacent critical structures in this setting is safe and contributes to improved functional outcomes. Cancer 2014;120:2866–2875 . © 2014 American Cancer Society .