Long-term outcome of patients with American Joint Committee on Cancer stage IIB extremity soft tissue sarcomas

Purpose: It has been suggested that patients with small (< 5 cm), high-grad e extremity soft tissue sarcomas (STS) have an excellent overall prognosis and, consequently may not require adjuvant therapies. Patients and Methods: A comprehensive review of all patients with extremity STS treated at a tertiary care cancer hospital over a 9-year period (Janua ry 1984 to December 1992) was performed. Prognostic factors, treatment data , and long-term outcome were evaluated in the subset of 111 patients with A merican Joint Committee on Cancer stage IIB (G3/4, T1a/b) disease. Results: The median tumor size was 3.0 cm (range, 0.6 to 4.9 cm), and 55 tu mors (50%) were deep in location. All patients underwent surgical resection ; 68 (61%) received pre- or postoperative radiotherapy, and 32 (29%) receiv ed doxorubicin-based chemotherapy. The median follow-up was 76 months. Fort y patients (36%) experienced 59 recurrences. First recurrences occurred at local, regional, and distant sites in 21, five, and 14 patients, respective ly. The 5-year actuarial local recurrence-free, distant recurrence-free, di sease-free, and overall survival rates were 82%, 83%, 68%, and 83%, respect ively. The presence of a microscopically positive surgical margin was an in dependent adverse prognostic factor for both local recurrence (relative ris k [RR] = 3.75; 95% confidence interval [Cl], 1.25 ta 11.25; P = .02) and di sease-free survival (RR = 2.57; 95% CT, 1.33 to 4.98; P = .005). Conclusion: Event-free outcome for this subset of patients with high-grade STS does not seem as favorable as previously reported by other investigator s. patients who undergo maximal surgical resection with microscopically pos itive margins represent a subset of T1 STS patients who warrant considerati on for adjuvant therapies. (C) 1999 by American Society of Clinical Oncolog y.