SUPERFICIAL EXTREMITY SOFT-TISSUE SARCOMA - AN ANALYSIS OF PROGNOSTICFACTORS

Background: Experience with soft tissue sarcoma has suggested that sup erficial tumors have a favorable prognosis. We evaluated the prognosti c features of this subset of sarcoma. Methods: Prospective data on 215 patients presenting to Memorial Sloan-Kettering Cancer Center with pr imary extremity superficial soft tissue sarcomas between July 1, 1982 and July 1, 1996 were analyzed. Superficial sarcomas were defined as s ubcutaneous tumors not invading the investing fascia of the muscle. An alysis was by univariate and multivariate tests for local recurrence, metastasis, and tumor mortality. Results: Ninety (42%) patients were o ver 50 years of age, 115 (53%) had high-grade tumors, 53 (25%) had tum ors greater than or equal to 5 cm, and 18 (8%) had positive margins fo llowing definitive resection. Median follow-up was 45 months (range 2 days to 151 months), 31 (14%) patients had local recurrences, 20 (9%) had distant metastases, and 15 (7%) died of disease. Five- and 10-year actuarial disease-specific survivals were 91% and 85%, respectively. On multivariate analysis, age >50 years predicted local recurrence (RR 5.7; 95% CI, 2.4-13.3; p < 0.0001). High grade (RR 4.2; 95% CI, 1.4-1 2.7; p < 0.006), and size greater than or equal to 5 cm (RR 4.4; 95% C I, 1.8-11; p < 0.002) predicted distant metastases. High grade (RR 7; 95% CI, 1.5-31.4; p < 0.003), size greater than or equal to 5 cm (RR 6 .9; 95% CI, 2.3-20.8; p < 0.0006), and positive margins (RR 3.8; 95% C I, 1.2-12.4; p < 0.006) predicted tumor mortality. Conclusion: Primary superficial extremity soft tissue sarcomas have a favorable prognosis . Size and grade of superficial tumors are the strongest factors in pr edicting survival.