Clinical importance of late recurrence in soft-tissue sarcomas

Background and Objectives: Soft-tissue sarcomas (STS) represent a diverse h istologic group of malignancies at risk for local and distant failure. We s tudied the impact of late (5 or more years) vs. early recurrence (less than 5 years) on subsequent outcome. Methods: Four hundred sixty-eight patients with STS treated between 1962 an d 1992 were evaluated for late (n = 39; 8%) or early (n = 253; 54%) recurre nce. Clinical and pathologic factors were reviewed. Survival data were anal yzed by the Kaplan-Meier method and the log-rank test. Results: Of the 39 patients with a late recurrence (median follow-up 156 mo nths), 18 patients had local recurrence, 7 patients developed distant recur rence, and 14 patients had local and distant recurrence. Thirty patients wi th late local and/or distant recurrence underwent complete or wide excision (n = 16), amputation (n = 4), or local resection(n = 10). The overall 5-ye ar survival rate following late recurrence was 61%. The 5-year overall surv ival rate was statistically better for patients with a late local recurrenc e alone than for patients with distant failure, 94% vs. 36%, respectively ( P = 0.003). Neither the site of the primary STS, age, primary margin status , nor histology had any effect on subsequent local or distant failure and s ubsequent survival. Conclusions: These data suggest that an aggressive approach is appropriate in patients who present with late recurrence (more than 5 years) following treatment of the primary STS. Impressive survival rates can be achieved in the treatment of local recurrences. (C) 2000 Wiley-Liss, Inc.