SURVIVAL IN PRIMARY SOFT-TISSUE SARCOMA OF THE EXTREMITIES AND TRUNK

Background: Soft tissue sarcomas (STS) of the extremities are rare. Th e purpose of this study was to identify prognostic risk factors associ ated with survival in patients with primary extremity and truncal STS. Methods: Patient, tumor, and pathologic data from 149 consecutive pat ients with localized primary STS of the extremities and trunk were ana lyzed using Kaplan-Meier and Cox regression techniques to identify uni variate and multivariate risk factors. A subgroup analysis was perform ed to compare factors predictive of survival in patients who received treatment before (n=50) and after (n=99) treatment was standardized in 1988. Results: The 5-year survival rate was 76.5% with an average fol low-up of 6 years. Local recurrence occurred in 23% of all patients, 4 0% before 1988 and 15% after 1988 (P < 0.0001). Risk factors associate d with survival included resection quality (RO vs. R1; P < 0.0001), er a of operation (P = 0.002), local recurrence (P < 0.001), UICC stage ( P < 0.0001), tumor size (P < 0.001), tumor depth (P = 0.002), regional lymph nodes (P < 0.0001), and histology (P < 0.0001). Multivariate an alysis revealed that tumor size, tumor depth, and resection quality we re independent risk factors of survival. Conclusions: These results in dicate that management of STS in a specialized institution improves ov erall survival. Resection quality is the most important risk factor of survival. Therefore, effort should be made during primary treatment o f STS to achieve wide, tumor-free resection margins.