OBJECTIVE: To define the significance of positive microscopic resection margins in a large cohort treated for soft tissue sarcoma. METHODS: The authors analyzed 2,084 patients with localized primary soft tissue sarcoma (all anatomic sites) treated from 1982 to 2000. Clinicopathologic variables studied included tumor site, size, depth, histologic type, grade, and resection margin status. Treatment other than resection was not analyzed. Study endpoints included local and distant recurrence-free and disease-specific survival rates, estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using the log-rank test and the Cox proportional hazards model. RESULTS: Median follow-up was 50 months. After primary resection, 1,624 (78%) patients had negative and 460 (22%) had positive resection margins. Having positive margins nearly doubled the risk of local recurrence and increased the risk of distant recurrence and disease-related death. Seventy-two percent of patients with positive margins had no recurrence. Resection margin did not predict local control for retroperitoneal sarcomas or fibrosarcomas. Resection margin remained significantly associated with distant recurrence-free survival and disease-specific survival across all subsets after adjusting for other prognostic variables. The overall 5-year disease-specific survival rates for negative and positive margins were 83% and 75%. CONCLUSIONS: Positive microscopic resection margins significantly decrease the local recurrence-free survival rate for other-than-primary fibrosarcoma and retroperitoneal sarcomas, and independently predict distant recurrence-free survival rates and disease-specific survival rates for all patient subsets. Adjuvant therapy should be considered in the management of soft tissue sarcoma to increase local control. Because 72% of positive margins did not equate with inevitable local recurrence, considerable clinical judgment is required in considering additional treatment. Microscopic resection margins should be considered for inclusion in staging systems and treatment algorithms that address local recurrence.
OBJECTIVE: To define the significance of positive microscopic resection margins in a large cohort treated for soft tissue sarcoma. METHODS: The authors analyzed 2,084 patients with localized primary soft tissue sarcoma (all anatomic sites) treated from 1982 to 2000. Clinicopathologic variables studied included tumor site, size, depth, histologic type, grade, and resection margin status. Treatment other than resection was not analyzed. Study endpoints included local and distant recurrence-free and disease-specific survival rates, estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using the log-rank test and the Cox proportional hazards model. RESULTS: Median follow-up was 50 months. After primary resection, 1,624 (78%) patients had negative and 460 (22%) had positive resection margins. Having positive margins nearly doubled the risk of local recurrence and increased the risk of distant recurrence and disease-related death. Seventy-two percent of patients with positive margins had no recurrence. Resection margin did not predict local control for retroperitoneal sarcomas or fibrosarcomas. Resection margin remained significantly associated with distant recurrence-free survival and disease-specific survival across all subsets after adjusting for other prognostic variables. The overall 5-year disease-specific survival rates for negative and positive margins were 83% and 75%. CONCLUSIONS: Positive microscopic resection margins significantly decrease the local recurrence-free survival rate for other-than-primary fibrosarcoma and retroperitoneal sarcomas, and independently predict distant recurrence-free survival rates and disease-specific survival rates for all patient subsets. Adjuvant therapy should be considered in the management of soft tissue sarcoma to increase local control. Because 72% of positive margins did not equate with inevitable local recurrence, considerable clinical judgment is required in considering additional treatment. Microscopic resection margins should be considered for inclusion in staging systems and treatment algorithms that address local recurrence.
Authors: Martin D McCarter; Cristina R Antonescu; Karla V Ballman; Robert G Maki; Peter W T Pisters; George D Demetri; Charles D Blanke; Margaret von Mehren; Murray F Brennan; Linda McCall; David M Ota; Ronald P DeMatteo Journal: J Am Coll Surg Date: 2012-07 Impact factor: 6.113
Authors: Eduardo N Novais; Bahtiyar Demiralp; Joseph Alderete; Melissa C Larson; Peter S Rose; Franklin H Sim Journal: Clin Orthop Relat Res Date: 2010-11 Impact factor: 4.176
Authors: Javier Martin-Broto; Nadia Hindi; Josefina Cruz; Javier Martinez-Trufero; Claudia Valverde; Luis M De Sande; Angeles Sala; Lorena Bellido; Ana De Juan; Jordi Rubió-Casadevall; Roberto Diaz-Beveridge; Ricardo Cubedo; Oscar Tendero; Diego Salinas; Isidro Gracia; Rafael Ramos; Silvia Baguè; Antonio Gutierrez; José Duran-Moreno; Antonio Lopez-Pousa Journal: Oncologist Date: 2018-11-08
Authors: Hira Shahzad Sardar; Qais Zai; Jason Gunn; Brian Pogue; Keith Paulsen; Kimberley Samkoe; Eric Henderson Journal: Proc SPIE Int Soc Opt Eng Date: 2019-03-07
Authors: Alexander L Lazarides; David L Kerr; Daniel P Nussbaum; R Timothy Kreulen; Jason A Somarelli; Dan G Blazer; Brian E Brigman; William C Eward Journal: Clin Orthop Relat Res Date: 2019-04 Impact factor: 4.176