scholarly journals Surgical Margins in Canine Cutaneous Soft-Tissue Sarcomas: A Dichotomous Classification System Does Not Accurately Predict the Risk of Local Recurrence

Animals ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 2367
Author(s):  
Lavinia Elena Chiti ◽  
Roberta Ferrari ◽  
Paola Roccabianca ◽  
Patrizia Boracchi ◽  
Francesco Godizzi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Cumulative Incidence ◽  
Soft Tissue Sarcomas ◽  
Prognostic Impact ◽  
Tissue Samples ◽  
Significant Difference ◽  
The Impact ◽  
Dichotomous Classification

Adjuvant treatments are recommended in dogs with incompletely excised cutaneous soft-tissue sarcoma (STS) to reduce the risk of local recurrence (LR), although guidelines are lacking on how to manage clean but close margins (CbCM). This retrospective study investigates the impact of CbCM on LR of canine STS. Ninety-eight surgically excised canine STS at first presentation were included. Tissue samples were routinely trimmed and analyzed. Cumulative incidence of LR was estimated for each category of margins (tumor-free, infiltrated, CbCM), and included CbCM in the tumor-free and infiltrated category, respectively. The prognostic impact on LR was then adjusted for relevant prognostic factors. Cumulative incidence of LR at three years differed significantly between the three categories (p = 0.016), and was estimated to be 42% with infiltrated margins, 23% with CbCM, 7% with tumor-free margins. Both when CbCM were grouped with infiltrated margins (p = 0.033; HR = 5.05), and when CbCM were grouped with tumor-free margins (p = 0.011; HR = 3.13), a significant difference between groups was found. STS excised with infiltrated margins had the greatest risk of LR. The rate of LR with CbCm was greater than recurrence rate of tumor-free margins. The category CbCM may be considered as a separate prognostic category.

Surgical procedures and prognostic factors for local recurrence of soft tissue sarcomas

2014 ◽  
Vol 19 (1) ◽  
pp. 141-149 ◽  
Author(s):  
Hideshi Sugiura ◽  
Yoshihiro Nishida ◽  
Hiroatsu Nakashima ◽  
Yoshihisa Yamada ◽  
Satoshi Tsukushi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Surgical Procedures ◽  
Soft Tissue Sarcomas

Status of Surgical Margins and Prognosis in Adult Soft Tissue Sarcomas of the Extremities: A Series of Patients Treated at a Single Institution

2005 ◽  
Vol 23 (1) ◽  
pp. 96-104 ◽  
Author(s):  
A. Gronchi ◽  
P.G. Casali ◽  
L. Mariani ◽  
R. Miceli ◽  
M. Fiore ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcomas ◽  
Hazard Ratio ◽  
Surgical Margins ◽  
Prognostic Impact ◽  
Positive Surgical Margins ◽  
Positive Margins ◽  
Prognostic Effect ◽  
Marginal Status

Purpose To explore the prognostic effect of microscopic marginal status after surgery for extremity soft tissue sarcomas. Patients and Methods We analyzed 911 consecutive patients surgically treated throughout a 20-year span at a single referral center. Six hundred forty-two were first seen with a primary tumor, and 269, with a locally recurrent tumor. All patients underwent macroscopically complete resection. Microscopic marginal status was negative (tumor size > 1 mm) in 748 patients and positive (≤ 1 mm) in 163 patients. Median follow-up was 107 months. Results Patients with primary disease had a lower disease-specific mortality in comparison to those first examined for recurrence (25% v 37%, respectively, at 10 years). Size, malignancy grade, depth, histotype, and local recurrence had a statistically significant prognostic effect at multivariable analysis, while microscopically positive surgical margins had not, though a trend in favor of negative margins was observed. However, an extra risk was observed for patients with positive margins after 3 to 5 years (hazard ratio, 1.8 after 5 years v 0.8 before 5 years). In patients treated for a local recurrence, the prognostic impact of positive margins was higher (hazard ratio, 1.6). Conclusion Positive surgical margins had a weak adverse prognostic effect, which was more pronounced for those patients escaping an early relapse. This would seem to justify a policy of surgical adequacy in adult soft tissue sarcomas, though clinical decision making in borderline presentations for conservative surgery might be reasonably flexible and shared with the patient. Once a local relapse has occurred, the impact of local treatments seems more critical.

Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities.

1996 ◽  
Vol 14 (5) ◽  
pp. 1679-1689 ◽  
Author(s):  
P W Pisters ◽  
D H Leung ◽  
J Woodruff ◽  
W Shi ◽  
M F Brennan
Keyword(s):  
Prognostic Factors ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Tumor Size ◽  
Recurrent Disease ◽  
Soft Tissue Sarcomas ◽  
Distant Recurrence ◽  
Disease Specific Survival ◽  
Positive Surgical Margins ◽  
Disease Specific

PURPOSE To identify specific independent adverse clinicopathologic factors for event-free survival in a cohort of consecutively treated patients with extremity soft tissue sarcomas. PATIENTS AND METHODS Prospectively collected data from a population of 1,041 adult patients with localized (American Joint Committee on Cancer [AJCC] stage IA to IIIB) extremity soft tissue sarcomas were analyzed. Patients were treated at a single institution between 1982 and 1994. Patient, tumor, and pathologic factors were analyzed by univariate and multivariate techniques to identify independent prognostic factors for the end points of local recurrence, distant recurrence, disease-specific survival, and post-metastasis survival. RESULTS The 5-year survival rate for this cohort of patients was 76%, with a median follow-up time of 3.95 years. Significant independent adverse prognostic factors for local recurrence were age greater than 50 years, recurrent disease at presentation, microscopically positive surgical margins, and the histologic subtypes fibrosarcoma and malignant peripheral-nerve tumor. For distant recurrence, intermediate tumor size, high histologic grade, deep location, recurrent disease at presentation, leiomyosarcoma, and nonliposarcoma histology were independent adverse prognostic factors. For disease-specific survival, large tumor size, high grade, deep location, recurrent disease at presentation, the histologic subtypes leiomyosarcoma and malignant peripheral-nerve tumor, microscopically positive surgical margins, and lower extremity site were adverse factors. For post-metastasis survival, only large tumor size ( > 10 cm) was an adverse prognostic factor. CONCLUSION The independent adverse prognostic factors for distant recurrence and disease specific survival differ from those identified for subsequent local recurrence. Patients with microscopically positive surgical margins or patients who present with locally recurrent disease are at increased risk for subsequent local recurrence and tumor-related mortality. Specific histopathologic subtypes are associated with increased risks for local failure and tumor-related mortality.

A prospective randomized trial of adjuvant brachytherapy in the management of low-grade soft tissue sarcomas of the extremity and superficial trunk.

1994 ◽  
Vol 12 (6) ◽  
pp. 1150-1155 ◽  
Author(s):  
P W Pisters ◽  
L B Harrison ◽  
J M Woodruff ◽  
J J Gaynor ◽  
M F Brennan
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
Systemic Disease ◽  
Soft Tissue Sarcomas ◽  
Adjuvant Radiation ◽  
Low Grade ◽  
Recurrence Rates ◽  
Tumor Bed ◽  
The Impact

PURPOSE This study was designed to evaluate the impact of adjuvant brachytherapy (BRT) on local and systemic recurrence rates in patients with low-grade sarcoma. PATIENTS AND METHODS Forty-five patients with histologic low-grade, completely resected soft tissue sarcomas of the extremity or superficial trunk were entered onto this trial. Following resection of all gross disease, patients were randomized to the BRT arm (n = 22) or to the no-BRT arm (n = 23). On the fifth or sixth postoperative day, catheters were loaded with iridium 192 to deliver a dose of 45 Gy to the tumor bed over 4 to 6 days. RESULTS The two groups were evenly distributed with respect to the distribution of presentation status (primary v recurrent), tumor site (trunk v extremity, proximal v distal extremity), tumor size (< 5 cm v > or = 5 cm), tumor depth (superficial v deep), and microscopic tumor margins (positive v negative). The predominant histopathologic diagnosis in each group was liposarcoma (BRT, 13 of 22 [59%]; no BRT, 14 of 23 [61%]) with other histopathologic subtypes evenly distributed between the two groups. The median follow-up duration among the ongoing survivors is 67 months. One patient in the BRT group developed systemic disease and died of progressive disease. Local recurrence occurred in five of 23 patients (22%) in the no-BRT group and six of 22 patients (27%) in the BRT group (P = .60). CONCLUSION Adjuvant radiation in the form of BRT does not appear to decrease local recurrence rates following complete resection of low-grade extremity and superficial trunk soft tissue sarcomas. Other adjuvant approaches, such as external-beam radiotherapy, are required to have a significant impact on local recurrence rates in this group of patients.

scholarly journals What are the Results of Resection of Forearm Soft Tissue Sarcoma?

2021 ◽  
Author(s):  
Eiji Nakata ◽  
Tomohiro Fujiwara ◽  
Toshiyuki Kunisada ◽  
Ryuichi Nakahara ◽  
Toshiyuki Watanabe ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Rating Scale ◽  
Univariate Analysis ◽  
Soft Tissue Sarcomas ◽  
Musculoskeletal Tumor Society ◽  
Free Survival ◽  
Msts Score ◽  
Unplanned Excision ◽  
Significant Difference

Abstract Only few reports have assessed the characteristics and oncological and functional outcomes of forearm soft tissue sarcomas (STS). Then, we aimed to investigate the clinical features and survival-related factors for forearm STS who underwent surgical excision at our institution. There were 38 patients. Fourteen patients (41%) were referred to our institution after an unplanned excision and tumor size and grade were significantly associated with the receipt of it. The postoperative median Musculoskeletal Tumor Society rating scale (MSTS) score was 28. Bone resection or major nerve palsy was the only factor influencing the postoperative MSTS score (P < 0.001). There was no significant difference in MSTS scores according to the reconstruction procedures (the use of flap or tendon reconstruction). The 5-year local recurrence-free survival (LRFS) rate was 86%. Univariate analysis revealed that the histological diagnosis of myxofibrosarcoma was the only factor that influenced LRFS (P = 0.047). The 5-year metastasis-free survival rate was 77%. The 5-year overall survival (OS) rate was 94%. Age was the only factor that influenced OS (P = 0.01). In conclusion, reconstruction of the skin and tendon can compensate for function. Careful follow-up is important, especially in patients with myxofibrosarcoma, due to its likelihood of local recurrence.

scholarly journals The Impact of Surgical Margins and Adjuvant Radiotherapy in Patients with Undifferentiated Pleomorphic Sarcomas of the Extremities: A Single-Institutional Analysis of 192 Patients

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 362 ◽  
Author(s):  
Ole Goertz ◽  
Andreas Pieper ◽  
Leon von der Lohe ◽  
Ingo Stricker ◽  
Mehran Dadras ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Radiotherapy ◽  
Prognostic Significance ◽  
Soft Tissue Sarcomas ◽  
Surgical Margins ◽  
Prognostic Impact ◽  
Curative Intent ◽  
Primary Tumors ◽  
The Impact

Background: Undifferentiated pleomorphic sarcomas are a frequent subtype within the heterogeneous group of soft tissue sarcomas. As the attainment of negative margins can be complicated at the extremities, we determined the prognostic significance of surgical margins in our patient population. Methods: We retrospectively determined the relationship between local recurrence-free survival (LRFS), overall survival (OS), and potential prognostic factors in 192 patients with UPS of the extremities who were suitable for surgical treatment in curative intent. The median follow-up time was 5.1 years. Results: The rates of LRFS and OS after 2 years were 75.7% and 87.2% in patients with R0-resected primary tumors and 49.1% and 81.8% in patients with R1/R2-status (LRFS: p = 0.013; OS: p = 0.001). Adjuvant radiotherapy significantly improved LRFS (5-year: 67.6% vs. 48.4%; p < 0.001) and OS (5-year: 82.8 vs. 61.8; p = 0.016). Both, negative margins and adjuvant radiotherapy were found to be independent prognostic factors in multivariate analysis. Conclusions: The data from this study could underscore the beneficial prognostic impact of negative margins on LRFS and OS. However, the width of negative margins seemed to be not relevant. Notably, adjuvant radiotherapy was not only able to decrease the risk of local failure but also improved OS in a significant manner.

scholarly journals The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3534
Author(s):  
Rebekka Götzl ◽  
Sebastian Sterzinger ◽  
Andreas Arkudas ◽  
Anja M. Boos ◽  
Sabine Semrau ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Reconstructive Surgery ◽  
Wound Closure ◽  
Soft Tissue Sarcomas ◽  
Comprehensive Cancer Center ◽  
Complication Rates ◽  
Primary Wound Closure ◽  
The Impact

Background: Soft tissue sarcoma (STS) treatment is an interdisciplinary challenge. Along with radio(chemo)therapy, surgery plays the central role in STS treatment. Little is known about the impact of reconstructive surgery on STS, particularly whether reconstructive surgery enhances STS resection success with the usage of flaps. Here, we analyzed the 10-year experience at a university hospital’s Comprehensive Cancer Center, focusing on the role of reconstructive surgery. Methods: We performed a retrospective analysis of STS-patients over 10 years. We investigated patient demographics, diagnosis, surgical management, tissue/function reconstruction, complication rates, resection status, local recurrence and survival. Results: Analysis of 290 patients showed an association between clear surgical margin (R0) resections and higher-grade sarcoma in patients with free flaps. Major complications were lower with primary wound closure than with flaps. Comparison of reconstruction techniques showed no significant differences in complication rates. Wound healing was impaired in STS recurrence. The local recurrence risk was over two times higher with primary wound closure than with flaps. Conclusion: Defect reconstructions in STS are reliable and safe. Plastic surgeons should have a permanent place in interdisciplinary surgical STS treatment, with the full armamentarium of reconstruction methods.

Prognostic Impact of FLT3 Mutation Load in NPM1 Mutated AML.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 826-826 ◽  
Author(s):  
Susanne Schnittger ◽  
Tamara Weiss ◽  
Claudia Haferlach ◽  
Wolfgang Kern ◽  
Torsten Haferlach
Keyword(s):  
Prognostic Factors ◽  
Prognostic Impact ◽  
Flt3 Mutation ◽  
Group 4 ◽  
Significant Difference ◽  
Equity Ownership ◽  
Per Se ◽  
Group 5 ◽  
The Impact ◽  
Wildtype Allele

Abstract Abstract 826 According to the new WHO classification NPM1 mutated AML is defined as a provisional entity. Those AML without FLT3-ITD (also referred to as FLT3-LM) are regarded as prognostically favorable whereas those with detectable FLT3-ITD in addition are defined as unfavorable. However, some previous studies not taking NPM1 status into account have shown that the prognostic impact of the FLT3 mutation is highly dependent on the load of the mutation. To evaluate a possible impact of FLT3 load in NPM1 mutated AML we have quantified the FLT3 load in 641 NPM1 mutated AML.The cohort was composed of 341 females and 300 males with a median age of 65.2 years (range 17.8-88 years). The NPM1 mutation was detected by melting curve analysis whereas the FLT3-ITD was quantitatively analysed by fragment analysis (Gene Scan, 3130 sequence detection system, ABI). The FLT3-ITD load was quantified as the ratio of the mutation compared to the wildtype allele. All ratios >1 are indicative for allelic loss of the wildtype allele (wt). Overall in 242/641 (37.8%) of the NPM1 mutated AML an FLT3- ITD was detected. The length of the mutation (LM) varied between 9 and 579 bp (median: 51 bp). The ratio of FLT3- ITD was in the range between 0.016 and 44.85 (median: 0.565). Using Cox regression analysis we demonstrated that increasing FLT3-ITD/wt ratio has a significantly unfavorable influence on EFS (p=0.028) . At next, for Kaplan Meier analysis 3 groups were defined according to FLT3-ITD/wt ratio: 1) only FLT3wt (n=398); 2) FLT3-ITD/wt ratio ≤1 (n=189) and 3) FLT3-ITD/wt ratio ≥1 (n=53). It was shown that the FLT3wt group had the best median EFS of 230 days compared to 203 day in group 2 (p=0.032) and only 86 days in group 3 (p<0.001). In a next step the FLT3 ratios were further subdivided into smaller groups 1) only WT (n=398), 2) ratio <0.25 (n=63) 3) ratio > 0.25 but <0.5 (n=44); 4) ratio ≥0.5 but <1 (n=82) 5) ratio ≥1 (n=53). Although the median EFS was continuously decreasing from group 1 to 5 (230 vs 200 vs 198 vs 96 vs 86 days, respectively) a significant difference compared to the FLT3wt group was only detected for group 4 (p=0.014) and group 5 (p<0.001). This analysis demonstrated that only FLT3-ITD/wt ratios ≥0.5 led to inferior outcome in NPM1 mutated AML. The impact of the FLT3/wt ratio on overall survival (OS) could also be detected only for group 5 with a median OS of 142 days compared to 293 days in the FLT3-WT group (p<0.002) and for group 4 (median 147 days) (p=0.033), respectively. In addition other known prognostic factors were analysed for EFS: karyotype (p=0.788; n.s.), gender (p=0.042; better for female) age (p<0.001), WBC (p<0.001), FLT3-status irrespective of ratio (p=0.001) and FLT3-ITD length (p=0.002). In a multivariate analysis only age (p<0.001), WBC (p=0.001) and FLT3-ITD/wt ratio (p=0.042) came out to be independent prognostic factors in NPM1 mutated AML. For OS ratios ≥0.5 came out to be more important than FLT3 status per se (0=0.044 vs. p=0.359). Subsequently ratios '0.5 were multivariately tested against age and WBC. All three parameters came out to be of independent significance for OS (p<0.001, p=0.001, and p=0.008, respectively). In conclusion, this study clearly demonstrates that not FLT3-ITD status per se is predictive for survival in NPM1 mutated AML but ratios of FLT3-ITD load has to be taken into account. Only ratios of ≥0.5 demonstrated to have a significant impact on prognosis in NPM1 mutated AML. This data has enormous implication on clinical decision making in AML including the option of allogeneic transplantation in first CR. Disclosures: Schnittger: MLL Munich Leukemia Lab: Equity Ownership. Weiss:MLL Munich Leukemia Laboratory: Employment. Haferlach:MLL Munich Leukemia Lab: Equity Ownership. Kern:MLL Munich Leukemia Laboratory: Equity Ownership. Haferlach:MLL Munich Leukemia Laboratory: Equity Ownership.

scholarly journals Management and outcome of acral soft-tissue sarcomas

2018 ◽  
Vol 100-B (11) ◽  
pp. 1518-1523 ◽  
Author(s):  
B. J. F. Dean ◽  
H. Branford-White ◽  
H. Giele ◽  
P. Critchley ◽  
L. Cogswell ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Tumour Size ◽  
Epithelioid Sarcoma ◽  
Soft Tissue Sarcomas ◽  
Amputation Rate ◽  
Increased Risk ◽  
Significant Difference ◽  
Partial Amputation

Aims The aim of this study was to evaluate the surgical management and outcome of patients with an acral soft-tissue sarcoma of the hand or foot. Patients and Methods We identified 63 patients with an acral soft-tissue sarcoma who presented to our tertiary referral sarcoma service between 2000 and 2016. There were 35 men and 28 women with a mean age of 49 years (sd 21). Of the 63 sarcomas, 27 were in the hands and 36 in the feet. The commonest subtypes were epithelioid sarcoma in the hand (n = 8) and synovial sarcoma in the foot (n = 11). Results In 41 patients (65%), the tumour measured less than 5 cm in its largest dimension (median size 3 cm (2 to 6)); 27 patients (43%) were diagnosed after inadvertent excision prior to their referral to the specialist sarcoma unit. After biopsy and staging, primary surgical intervention at the sarcoma unit was excision and limb salvage in 43 (68%), partial (digit or ray) amputation in 14 (22%), and more proximal amputation in six (10%). At final follow up, local recurrence had been treated by one partial amputation and six amputations, resulting in a partial amputation rate of 24% and a proximal amputation rate of 19%. The five-year survival rate was 82%. Patients who underwent inadvertent excision showed no statistically significant difference in survival or local recurrence, but were more likely to undergo amputation (p = 0.008). Large tumour size (> 5 cm) was associated with lower survival (p = 0.04) and a higher risk of local recurrence (p = 0.009;). Conclusion Most acral soft-tissue sarcomas measure less than 5 cm at presentation, indicating that while size can be a useful prognostic factor, it should not be used as a diagnostic threshold for referral. Increased tumour size is associated with a higher rate of local recurrence and reduced survival. Sarcoma excision with limb preservation does not result in an increased risk of local recurrence. Cite this article: Bone Joint J 2018;100-B:1518–23.

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