Assessing prognosis for high-grade soft-tissue sarcomas: Search for a marker

Background: Although improved staging technology, limb-sparing surgery, and adjunctive radiation and chemotherapy have improved the outlook for patients with malignant soft-tissue tumors of the trunk and extremities, it is evident that we cannot predict which patients will develop distant metastases. Although local control is now frequently achieved, most series of high-grade soft-tissue sarcomas carry a mortality rate of >50%. Methods: In a retrospective study of 93 patients with high-grade sarcomas treated between 1986 and 1992, for whom complete studies including size and Volume measurements and DNA ploidy determinations as assessed by now cytometry were available, a search for a marker for increased risk of metastasis or death was performed. Results: Grade of the lesion, sex, diagnosis, anatomical site, ploidic data (including mean DNA index and presence of an aneuploid peak), and treatment factors (including type of surgery, local recurrence, or radiation protocol) did not correlate with outcome. Age (younger patients did better), size (greatest diameter) and volume, and positive margins at surgery correlated with total survival. Conclusions: The results of the study, although negative, point out that using anatomical site, diagnosis, or ploidic analysis offers little toward anticipating outcome, whereas the size of the tumor is important.