Abstract
BACKGROUND.
The purpose was to define the rate of local recurrence (LR) and identify prognostic factors for LR in patients with extremity soft‐tissue sarcoma (STS) treated with limb‐sparing surgery and a pathologically negative re‐resection specimen without radiotherapy (RT).
METHODS.
A review of the prospective sarcoma database identified 200 patients with primary, nonmetastatic, extremity STS treated with limb‐sparing surgery between June 1982 and December 2002 who had a pathologically confirmed negative re‐resection. None of the patients had adjuvant RT. Univariate and multivariate analyses were performed to determine clinicopathologic factors associated with LR.
RESULTS.
With a median follow‐up of 82 months the 5‐year actuarial LR rate was 9%. Factors associated with higher LR rates on univariate and multivariate analysis were older age, stage III presentation, and histology. The 5‐year LR rate was 5% for those <50 compared with 15% for those ≥50 (P = .001). For patients with stage III the LR rate was 26% versus 7% for those with stage I/II (P < .001). On multivariate analysis only age ≥50 (relative risk [RR] 3.3; P = .02) and stage III disease (RR 3.4; P = .01) remained significant predictors for LR. When the cohort of patients was divided into 3 groups based on the number of risk factors present, the 5‐year LRs were as follows: no risk factors (stage I/II and <50 years old) 4%, 1 risk factor (stage III or ≥50) 12%, and 2 risk factors (stage III and ≥50) 31% (P < .01).
CONCLUSIONS.
Patients with a pathologically negative re‐excision represent a heterogeneous group. Whereas the overall rate of local recurrence at 5 years was 9% for the entire cohort, patients with older age and/or stage III disease had a higher rate of LR. Therefore, treatment decisions especially with regard to adjuvant RT should be individualized and not be based solely on the finding of a negative re‐resection. Cancer 2008. © 2008 American Cancer Society.