PREDICTIVE FACTORS FOR COMPLETE REMOVAL IN SOFT-TISSUE SARCOMAS - A RETROSPECTIVE ANALYSIS IN A SERIES OF 592 CASES

Background and Objectives: In order to specify the indications for con servative surgery and preoperative therapeutic approaches of soft tiss ues sarcomas (STS), we looked for the clinico-pathological parameters associated with the failure to obtain a complete removal (CRm) of the tumor. Methods: We retrospectively analyzed a series of 592 cases of p rimary non-metastatic STS. Surgery was performed in 495 cases as a pri mary treatment and in 88 cases after chemo- or radiotherapy. Nine pati ents were treated by chemotherapy-radiotherapy. In a univariate analys is, 20 parameters were tested for their association with CRm. A multiv ariate analysis was then used to define the independent parameters lin ked to the achievement of a CRm. Results: In the univariate analysis, 15 parameters were found to be linked to the achievement of a CRm. Thr ee of them proved to be independent in the multivariate analysis: T in the TNM classification, tumor location, and tumor necrosis. By the co mbination of these risk factors, four groups of patients were defined, with respective rates of CRm of 97% (no factor), 95% (one factor), 70 % (two factors), and 48% (three factors). Conclusions: The achievement of a CRm after surgery of STS depends not only on the accessibility o f the lesion, but also on tumor aggressiveness, a reflection of which is necrosis. The detection of necrosis by imaging procedures may thus help predicting the resectability of tumors and defining the indicatio ns for neoadjuvant therapies, likely to broaden the use of conservativ e surgery. (C) 1997 Wiley-Liss, Inc.