Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: A series of patients treated at a single institution

被引:211
作者
Gronchi, A
Casali, PG
Mariani, L
Miceli, R
Fiore, M
Lo Vullo, S
Bertulli, R
Collini, P
Lozza, L
Olmi, P
Rosai, J
机构
[1] Ist Nazl Studio & Cura Tumori, Dept Surg, I-20133 Milan, Italy
[2] Ist Nazl Studio & Cura Tumori, Dept Canc Med, I-20133 Milan, Italy
[3] Ist Nazl Studio & Cura Tumori, Dept Biostat, I-20133 Milan, Italy
[4] Ist Nazl Studio & Cura Tumori, Dept Pathol, I-20133 Milan, Italy
[5] Ist Nazl Studio & Cura Tumori, Dept Diagnost Imaging & Radiotherapy, I-20133 Milan, Italy
关键词
D O I
10.1200/JCO.2005.04.160
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose of microscopic marginal status after surgery for extremity To explore the prognostic effect 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 (:5 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.
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页码:96 / 104
页数:9
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