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The impact of unplanned excisions of truncal/extremity soft tissue sarcomas: A multi‐institutional propensity score analysis from the US Sarcoma Collaborative
Author(s) -
Zaidi Mohammad Y.,
Ethun Cecilia G.,
Liu Yuan,
Poultsides George,
Howard J. Harrison,
Mogal Harveshp,
Tseng Jennifer,
Votanopoulos Konstantinos,
Fields Ryan C.,
Cardona Kenneth
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25521
Subject(s) - medicine , soft tissue sarcoma , propensity score matching , hazard ratio , sarcoma , overall survival , retrospective cohort study , soft tissue , surgery , pathology , confidence interval
Objective Our aim was to compare outcomes in patients who underwent unplanned excisions (UE) of soft‐tissue sarcomas (STS) against patients with planned excisions (PE). Methods The retrospective 7‐institution US Sarcoma Collaborative database was used. Patients with curative‐intent resection of truncal/extremity STS between 2000 and 2016 were included. Propensity score weighting analysis (PSWA) was performed. Endpoints were locoregional recurrence‐free survival (LRFS), distant metastasis‐free survival (DMFS), and disease‐specific survival (DSS). Results One thousand five hundred and ninety‐six patients were included. Eighty‐two percent (n = 1315) underwent PE and 18% (n = 281) underwent UE. Compared with PE, patients with UE were younger with smaller tumors with similar tumor grade. Unmatched analysis revealed PE was associated with worse DMFS (hazard ratio [HR] 1.95, P = .009) and DSS (HR 1.78, P = .039), but not LRFS compared with UE. On PSWA, UE had earlier LRFS (3‐year LRFS: 80.5% vs 89.8%, P = .039), but not DMFS or DSS. By grade, patients with high‐grade tumors and UE had worse LRFS (1‐year LRFS: 90% vs 94%, P = .015), but similar DMFS and DSS compared with PE. In low‐grade patients, UE and PE had similar LRFS, DMFS, or DSS. Conclusions UE of STS is not associated with worse prognosis compared to PE, though UE is associated with earlier locoregional recurrence in patients with high‐grade tumors. Multimodality therapy is needed to achieve improved outcomes in these patients.