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The influence of anatomic location on outcome in patients with soft tissue sarcoma of the extremity
Article first published online: 3 JAN 2003
Copyright © 2003 American Cancer Society
Volume 97, Issue 2, pages 485–492, 15 January 2003
How to Cite
Gerrand, C. H., Bell, R. S., Wunder, J. S., Kandel, R. A., O'Sullivan, B., Catton, C. N., Griffin, A. M. and Davis, A. M. (2003), The influence of anatomic location on outcome in patients with soft tissue sarcoma of the extremity. Cancer, 97: 485–492. doi: 10.1002/cncr.11076
- Issue published online: 3 JAN 2003
- Article first published online: 3 JAN 2003
- Manuscript Accepted: 22 AUG 2002
- Manuscript Received: 12 AUG 2002
- Manuscript Revised: 12 AUG 2002
- Wishbone Trust
- Depuy UK
- Stryker Howmedica
- Canadian Institutes of Health Research
- local recurrence;
- surgical procedures;
The anatomic location of an extremity soft tissue sarcoma may influence the patient's presentation, management, and local and systemic recurrence rates. The objective of this study was to compare the presentation, management, and outcome of patients with soft tissue sarcomas of the upper extremity and the lower extremity.
Prospectively collected data from patients who underwent limb-sparing surgery for extremity soft tissue sarcoma between January, 1986 and April, 1997 were analyzed. Local recurrence free rates and metastasis free rates were calculated using the method of Kaplan and Meier. Univariate and multivariate analyses of potential predictive factors were evaluated with the log-rank test and the Cox proportional hazards model.
Of 480 eligible patients, 48 patients (10.0%) had a local recurrence, and 131 patients (27.3%) developed distant metastasis. The median follow-up of survivors was 4.8 years (range, 0.1–12.9 years). Patients with upper extremity tumors had smaller lesions (6.0 cm vs. 9.3 cm; P < 0.001), more often underwent unplanned excision before referral (89 patients [64.0%] vs. 160 patients [46.9%]; P < 0.001), and less often received radiotherapy (98 patients [70.5%] vs. 289 patients [84.8%]; P < 0.001). The 5-year local recurrence free rate was 82% for patients with sarcomas of the upper extremity and 93% for patients with sarcomas of the lower extremity (P = 0.002). The 5-year metastasis free rate was 82% for patients with sarcomas of the upper extremity and 69% for patients with sarcomas of the lower extremity (P = 0.013).
Local recurrence was more frequent in patients who had sarcomas of the upper extremity compared with patients who had sarcomas of the lower extremity. Factors that contributed to this difference included histologic type, the use of radiotherapy, and local anatomy. Metastasis was more frequent among patients with sarcomas of the lower extremity, because those tumors tended to be large and deeper compared with upper extremity tumors. Cancer 2003;97:485–92. © 2003 American Cancer Society.