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Trauma

TUMOR GROWTH PATTERN: THE MISSING LINK BETWEEN SURGICAL MARGINS AND DISEASE FREE SURVIVAL IN ADULT SOFT TISSUE SARCOMA OF THE LIMBS? A SERIES OF 105 PATIENTS TREATED AT A SINGLE INSTITUTION

European Federation of National Associations of Orthopaedics and Traumatology (EFORT) - 12th Congress



Abstract

Purpose

To investigate the prognostic effect of surgical margins in soft tissue sarcoma on Local Recurrence (LRFS), Metastasis (MFS) and Disease Free Survival (DFS).

Patients and Methods

This is a retrospective, single center study of 105 consecutive patients operated with curative intent. Quality of surgery was rated according to the International Union Against Cancer classification (R0/R1) and a modification of this classification (R0M/R1M) to take into account growth pattern and skip metastases in margins less than 1mm. Univariate and multivariate analysis was done to identify potential risk factors. Kaplan-Mayer estimated cumulative incidence for LRFS, MFS and DFS were calculated. Survival curves were compared using Log rank tests.

Results

Estimated LRFS was 0.64 [0.52;0.76] at 5 years following R1 surgery, 0.9 [0.85;0.95] following R0 (p=0.023), 0.64 [0.519;0.751] following R1M surgery and 0.92 [0.87;0.96] following R0M (p=0.01). The R status was associated with DFS (p=0.028), but not MFS (p=0.156). The RM status was associated with both outcomes (p=0.001 and p=0.007). Multivariate analysis showed an independent association with LRFS for RM status (HR 6.77 [1.78–25.7], p=0.005), with DFS for RM status (HR 2.83 [1.47–5.43], p=0.001) and Grade (HR=3.17 [1.38–7.27], p=0.003) and with MFS for Grade (HR=3.96 [1.50–10.5], p=0.006).

Conclusions

In Soft Tissue Sarcoma, surgical margins are the strongest prognostic factor for LRFS. In this study, taking growth pattern and skip metastases into account for margins less than 1mm increased prognostic significance of surgical margins for LRFS, DFS and MFS.