A COMPARISON OF THE PROGNOSES FOR DEEP AND SUBCUTANEOUS SARCOMAS OF THE EXTREMITIES

We evaluated 172 patients who had a soft-tissue sarcoma of the extremi ty in order to determine whether the prognosis for a subcutaneous sarc oma was better than that for a deep sarcoma. At a median of thirty-six months after the biopsy or definitive operation at our hospital, six of the fifty-two patients who had had a subcutaneous sarcoma had died and one had had a local recurrence; in contrast, forty of the 120 pati ents who had had a deep sarcoma had died and eight had had a local rec urrence. Twenty-five (48 per cent) of the subcutaneous sarcomas were m alignant fibrous histiocytomas, and thirty-eight (73 per cent) were sm all (five centimeters or less in the largest dimension). The three yea r estimates of disease-free survival were 85 per cent for the patients who had a subcutaneous sarcoma and 54 per cent for those who had a de ep sarcoma (p = 0.002). Although the survival estimates remained signi ficantly different when the groups were matched for histological diagn osis and for intracompartmental location (p = 0.0001 and 0.0006, respe ctively), they were not significantly different when the groups were m atched for the size of the tumor (p = 0.42). A Cox proportional-hazard s model confirmed that a tumor size of more than five centimeters and the histological grade are the most significant prognostic factors (p = 0.0007 and p = 0.004, respectively): a tumor size of more than five centimeters was associated with a relative risk of 3.5 (95 per cent co nfidence interval, 1.7 to 7.3), and a higher histological grade was as sociated with a relative risk of 4.0 (95 per cent confidence interval, 1.6 to 10.3). Subcutaneous location, when considered separately, was not a significant prognostic factor (p = 0.45). The data indicate that a tumor size of more than five centimeters is a more important progno stic indicator than histological diagnosis, depth, or intracompartment al location.