Multifactorial analysis of long-term follow-up (more than 5 years) of primary extremity sarcoma

Background: The majority of survival studies in patients with extremity sof t tissue sarcoma have focused on early recurrence and mortality. There are few data addressing long-term follow-up and survival. Objective: To analyze survival and recurrence in patients with extremity so ft tissue sarcoma who survive for more than 5 years. Methods: Patients who underwent treatment for primary tumors (July 1982 to July 1994) and were followed up for more than 5 years were the subject of s tudy. Disease-specific and disease-free survival were determined actuariall y. Significance was evaluated using log-rank testing for univariate analysi s and Cox model stepwise regression for multivariate analysis. Results: A total of 495 patients with primary extremity rumors were treated before July 1989 and eligible for 5-year follow-up. Of these, 282 have bee n followed up for more than 5 years (median follow-up, 84.4 months). Actuar ial disease-specific survival of patients who survive for longer than 5 yea rs was 79% +/- 7% (+/-SEM) at 10 years, and of those who were metastasis fr ee at 5 years was 91% +/- 4% at 10 years. On univariate analysis, post-5-ye ar disease-specific survival was influenced by positive microscopic margin and initial tumor size of 5 cm or greater. On multivariate analysis, post-5 -year disease-specific survival was influenced only by positive margins. Conclusions: Based on these analyses, 21% of patients with primary extremit y sarcoma who survive for 5 years will die of disease within 5 years. Even of those who are metastasis free at 5 years, 9% will die of disease within 5 years. In contrast to early mortality, tumor grade has no influence on po st-5-year prognosis. Patients with positive microscopic margins are at risk for post-5-year disease-specific mortality and therefore require longterm follow-up and consideration For investigational therapy.