Soft tissue sarcoma of the upper extremity: Descriptive data and outcome in a population-based series of 108 adult patients

We report a population-based, 29-year review of 108 adult patients with sof t tissue sarcoma of the upper extremity who had a minimum follow-up period of 3 years. Fifty tumors were localized in the upper arm, 8 in the elbow, 4 0 in the forearm, and 10 in the hand. Thirty-four tumors were subcutaneous and 74 were deep-seated. The median tumor size was 6 cm. Malignant fibrous histiocytoma was the most. common histotype (n = 43), and grade IV (on a 4- grade scale) was the most common malignancy grade (n = 54). All but 6 patie nts underwent surgery; limb-sparing surgery of the primary tumor was perfor med in 89 patients. Twenty-four patients were given adjuvant radiotherapy; 11 received adjuvant chemotherapy. inadequate local treatment was more comm on in patients treated outside the tumor center. Local recurrence occurred in 15 of 28 with inadequate local treatment and in 16 of 74 patients with a dequate local treatment (20 of the 39 patients treated outside the center a nd 11 of the 63 patients treated at the center). At the latest follow-up vi sit, 32 patients had developed metastases, giving a 5-year metastasis-free survival rate of 0.72. In a multivariate analysis, tumor size larger than 5 cm and vascular invasion emerged as independent prognostic factors. Patien ts without these 2 factors had excellent survival. When compared with soft tissue sarcoma of the lower extremity or trunk wall, tumors in the upper ex tremity were smaller at the time of diagnosis and had a higher 5-year metas tasis-free survival rate. (J Hand Surg 1999;24A:668-674. Copyright (C) 1999 by the American Society for Surgery of the Hand.).