Superficial soft tissue sarcomas (S-STS): A study of 367 patients from the French Sarcoma Group (FSG) database (original) (raw)
Related papers
A staging system for soft-tissue sarcoma and its evaluation in relation to treatment
International Journal of Cancer, 1994
In order to define the significant factors for a staging system of soft-tissue sarcomas(STS), histologic and clinical findings in I90 adult patients with localized STS in the extremities and trunk were reviewed. The male-to-female ratio was I .2 I. The histologic grading of tumors was defined according t o the criteria recently proposed by us: tumors were low-grade in 65 cases, intermediate-grade in 57 cases and high-grade in 68 cases. The initial surgical procedure was as follows: intracapsular excision in 9 cases, marginal excision in I04 and wide local excision in 77, including I 5 amputations. The mode of treatment was surgery alone (I 0 I patients), surgery and chemotherapy (58), surgery and radiotherapy (22) and surgery and combined chemo-and radiotherapy (9). Univariate analysis revealed histologic grade, sex, tumor size and tumor depth to be significant prognostic factors. Multivariate analysis revealed histologic grade t o be the only independent factor for prognosis. Significant clinical factors in each histologic grade were then evaluated. In the low-grade group, local recurrence significantly affected prognosis. Most of the patients with local recurrence had had marginal resection as the initial surgical procedure. No clinical factors affecting prognosis in the intermediate-grade group could be determined. I n the high-grade group, patients with wide local excision and adjuvant chemotherapy had a better prognosis than those with marginal excision with or without adjuvant chemotherapy and wide local excision without chemotherapy (p = 0.09). In conclusion, histologic grade was the only significant factor for the staging of STS. On the basis of our staging system, different modalities of treatment for each grade of STS might be indicated; adequate surgery is essential for the prevention of local recurrence, which resulted in reduced mortality in patients with low-grade STS. For high-grade STS, the prevention of distant metastasis by combined extensive surgery and adjuvant chemotherapy may make long-term survival possible.
Metastasis in Soft Tissue Sarcomas: Prognostic Criteria and Treatment Perspectives
Cancer and Metastasis Reviews, 2002
Soft tissue sarcomas (STSs) are rare tumors, notorious for early hematogenous metastasizing. Metastatic disease is seldom amenable to curative treatment; therefore new treatment modalities are required. Treatment-related and tumor-related prognostic factors can be assessed to estimate the risk for subsequent metastases, as will be discussed. By this means, high-risk patients can be defined; they are the candidates for clinical trials mandatory for treatment development. The metastatic process as well as the reaction to chemotherapy depends on the biological make-up of the tumor. Current chemotherapy regimens do not improve the survival rates of patients with metastatic disease, due to resistance mechanisms of tumor cells. New drugs with direct access to the cell death machinery in tumor cells might contribute to more effective treatment of STS patients. Treatment related aspects of metastasis in STSs Local treatment Surgery. Surgery is the mainstay in current STS treatment. In most cases, a local recurrence can be prevented by surgery, with radiotherapy on indication. 21,22 However, despite the frequent success in local tumor control, the risk that distant metastases will develop seems to largely depend on tumor biological characteristics. The following section addresses the impact of surgery on the metastatic process. Furthermore, the role of surgery for metastatic STS lesions is discussed. Adequate surgical resection of STSs is of the utmost importance in order to minimize the risk for local recurrence. Non-radical surgery will inevitably lead to a local recurrence; nevertheless, radical resection does not warrant the avoidance of local recurrence. 21,23 The impact of local tumor control on the prevention of systemic disease is complicated to conceive. 24 Trovik et al. evaluated 559 patients with localized extremity or truncal STSs and found that the surgical margin width was not a risk factor for metastases. 25 Contradictory results were reported in a retrospective study of 111 extremity and truncal STSs. A wide tumor-negative margin (10mm or more) was prognostic for a prolonged disease free survival and a reduced rate of distant failure. 26 Analysis of margin status from 2,084 consecutive patients undergoing resection for primary STS showed that positive margins were linked with a significantly slightly higher rate of metastases: 27% versus 23% for negative margins. 12 This difference was mainly attributed by the development of metastases after 2 years from surgery for the primary tumor. Lewis et al. reported on the clinical outcome of a re-resection at Memorial Sloan-Kettering Cancer Center (MSKCC) after non-radical surgery of extremity STSs performed elsewhere. 27 The results were remarkable. Eighty-eight percent of the re-resected patients were disease free after 5 years, compared to 70% of the control group. The occurrence of metastases was lower within the re-resection group, also after correction for risk factors. The possibility of a biasing selection of patients with favorable prognosis into the re-resection group was suggested but could not confirmed by the authors. However, the number of referred patients not eligible for a re-resection, if any, was not mentioned. Such patients might be the ones with an unfavorable prognosis. Another explanation is that the combined treatment of re-resection and adjuvant therapy given at a highly specialized center had a beneficial effect on survival. 28 The results are not
Superficial soft tissue sarcomas: 10‑year survival outcomes
Oncology Letters, 2023
Cutaneous sarcomas comprise a broad group of rare, heterogeneous mesenchymal tumours. The present report describes a single centre experience regarding the management and the outcomes of patients with superficial soft tissue sarcomas (SSTS). Key prognostic factors in predicting overall survival (OS) and local relapse-free survival were determined. Data from 66 patients with SSTS treated surgically within Edinburgh and Lothian were collected in the context of a service evaluation. Patient demographics, tumour specifics and treatment, as well as 5-year OS and local recurrence, were analysed. Kaplan-Meier analysis was applied for survival curves, and mortality rate estimation and Cox regression were used to establish independent predictors. The mean estimated OS time was 57.2 months, with a 95% CI between 55.0 and 59.5 months. The median OS time could not be estimated because there is no time point during which the survival function has a value <50%. The death risk for a person with SSTS was increased by 7.3% (odds ratio, 1.073; 95% CI, 1.012-1.138) for every additional year of life. The estimated mean local relapse time was 58.5 months, with a 95% CI between 56 and 61 months. The median local relapse time could not be estimated since there is no time point during which the local recurrence function has a value <50%. In conclusion, out of all independent variables considered, none could statistically significantly explicate local relapse recurrence time. It is important that these rare tumours are treated in the context of a multidisciplinary team with consensus guidelines to assist decision-making.
Sarcoma, 2015
Introduction. Superficial soft tissue sarcomas (S-STS) are generally amenable to wide excision. We hypothesized that local recurrence (LR) should be low, even without radiation therapy (RT), and sought to examine the contribution of depth to LR and OS.Methods. Patients with S-STS were retrospectively reviewed. Demographics, tumor features, treatment received, and outcomes were analyzed.Results. 103 patients were identified. Median age was 55 years; 53% of patients were female. Tumor site was 39% in trunk, 38% in the lower extremity, 14% in the upper extremity, and 9% in other locations. The most common histology was 36% leiomyosarcoma. Median tumor size was 2.8 cm (range 0.2–14 cm). Sixty-six percent of tumors were of intermediate/high grade. RT was administered preoperatively in 6% of patients and postoperatively in 15% of patients. An R0 resection was accomplished in 92%. At a median follow-up of 34.2 months (range 2.3–176), 9 patients had a LR (8.7%). Tumor size and grade were no...
Misconceptions with staging of soft tissue sarcoma
Journal of Clinical Oncology
The authors clearly state that T1 tumors are less than 5 cm and T2 tumors are Ն5 cm. This is, in fact, not the case. The fifth edition of the American Joint Committee on Cancer Staging Manual 2 and the latest UICC TNM Classification of Malignant Tumors 3 for soft tissue sarcoma (STS) both specify that Յ5 cm is the dividing point for T1 tumors and that T2 tumors are greater than 5 cm. This may seem like a minor error on the surface, but when you consider the natural tendency for rounding off around 5 cm (or other size brackets), this can have a significant impact. Therefore, when Fleming et al claim that stage IIB STSs do not seem to have as favorable an event-free outcome as previously reported, this is not necessarily true. They should state that high-grade STSs less than 5 cm had an unexpectedly low event-free outcome in their series. This is because their article has a notably high percentage of superficial lesions compared with most series of extremity STS, and this makes the wider application of their conclusions inappropriate.
Plastic and reconstructive surgery. Global open, 2017
Soft-tissue sarcomas are most frequently located deep within myofascial compartments. Superficial soft-tissue sarcomas (S-STS) are relatively less common and may be managed differently than deep sarcomas because generous resection margins are often possible without sacrificing critical structures. We sought to investigate the frequency and types of soft-tissue reconstructive procedures that are required following excision of S-STS. We reviewed 457 consecutively treated patients with S-STS with a minimum 2-year follow-up from our prospectively maintained database between 1989 and 2009. Mean follow-up was 10.5 years (range, 2-23). Four hundred twenty-one tumors (91%) were excised with negative margins, 38 (8.3%) had microscopically positive margins, and three (0.7%) had grossly positive margins. One patient required an amputation. In 271 (58%) patients, the wounds were closed primarily. In comparison, 93 patients (20%) required a rotation flap, 70 (15%) required a split-thickness skin...
Nonreferral of Possible Soft Tissue Sarcomas in Adults: A Dangerous Omission in Policy
Sarcoma, 2009
The aim of this study is to compare outcomes in three groups of STS patients treated in our specialist centre: patients referred immediately after an inadequate initial treatment, patients referred after a local recurrence, and patients referred directly, prior to any treatment. Patients and methods. We reviewed all our nonmetastatic extremity-STS patients with a minimum followup of 2 years. We compared three patient groups: those referred directly to our centre (group A), those referred after an inadequate initial excision (group B), and patients with local recurrence (group C). Results. The study included 174 patients. Disease-free survival was 73%, 76%, and 28% in groups A, B, and C, respectively (P < .001). Depth, size, and histologic grade influenced the outcome in groups A and B, but not in C. Conclusion. Initial wide surgical treatment is the main factor that determines local control, being even more important than the known intrinsic prognostic factors of tumour size, depth, and histologic grade. The influence on outcome of initial wide local excision (WLE), which is made possible by referral to a specialist centre, is paramount.