ANALYSIS OF PROGNOSTIC FACTORS IN 1,041 PATIENTS WITH LOCALIZED SOFT-TISSUE SARCOMAS OF THE EXTREMITIES

Purpose: To identify specific independent adverse clinicopathologic fa ctors for event-free survival in a cohort of consecutively treated pat ients with extremity soft tissue sarcomas. Patients and Methods: prosp ectively 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 pat hologic factors were analyzed by univariate and multivariate technique s to identify independent prognostic factors for the end points of loc al 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. Sign ificant independent adverse prognostic factors for local recurrence we re age greater than 50 years, recurrent disease at presentation, micro scopically positive surgical margins, and the histologic subtypes fibr osarcoma and malignant peripheral-nerve tumor. For distant recurrence, intermediate tumor size, large tumor size, high histologic grade, dee p location, recurrent disease at presentation, leiomyosarcoma, and non liposarcoma histology were independent adverse prognostic factors. For disease-specific survival, large tumor size, high grade, deep locatio n, recurrent disease at presentation, the histologic: subtypes leiomyo sarcoma and malignant peripheral-nerve tumor, microscopically positive surgical margins, and lower extremity site were adverse factors. For postmetastasis survival, only large tumor size (> 10 cm) was an advers e prognostic factor. Conclusion: The independent adverse prognostic fa ctors for distant recurrence and disease-specific survival differ from those identified for subsequent local recurrence. Patients with micro scopically positive surgical margins or patients who present with loca lly recurrent disease are at increased risk for subsequent local recur rence and tumor-related mortality. Specific histopathologic subtypes a re associated with increased risks for local failure and tumor-related mortality. (C) 1996 by American Society of Clinical Oncology.