Local recurrence of localized soft tissue sarcoma

A new look at old predictors

Authors

  • David J. Biau MD, PhD,

    Corresponding author
    1. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    • University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 600 University Avenue, Room 476, Toronto, Ontario, Canada M5G 1X5
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    • Fax: (416) 586-8611

  • Peter C. Ferguson MD, MSc,

    1. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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  • Peter Chung MD,

    1. Sarcoma Site Group, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Anthony M. Griffin MSc,

    1. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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  • Charles N. Catton MD,

    1. Sarcoma Site Group, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Brian O'Sullivan MD,

    1. Sarcoma Site Group, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Jay S. Wunder MD, MSc

    1. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Abstract

BACKGROUND:

The objective of this study was to examine the effect of known predictors of local recurrence of soft tissue sarcoma in a competing risk setting.

METHODS:

The outcome of interest was the cumulative probability of local recurrence per category of relevant predictors, with death as a competing event. In total, 1668 patients with a localized soft tissue sarcoma of the extremity or trunk were included.

RESULTS:

Tumor size (hazard ratio, 3.3), depth (hazard ratio, 3.2), and histologic grade (hazard ratio, 4.5) were the variables that had the most effect on the risk of metastasis and, accordingly, were the most likely to induce competition. Surgical margins (hazard ratio, 3.3), histologic grade (hazard ratio, 2.1), presentation status (hazard ratio, 2.4), and tumor depth (hazard ratio, 1.5) were the variables that had the most effect on the risk of local recurrence. The 10-year cumulative probabilities of local recurrence were markedly different within categories for presentation status (P < .001) and surgical margin status (P < .001). However, because of the competing effect of death, there was little difference in the 10-year cumulative probabilities of local recurrence with regard to tumor depth (12% and 11.4% for deep and superficial tumors, respectively; P = .2), tumor size (10.6% and 13.3% for large and small tumors, respectively; P = .99), or histologic tumor grade (12.6%, 10.7%, and 11.1% for high, intermediate, and low-grade tumors, respectively; P = .17).

CONCLUSIONS:

Because of the competition between local recurrence and death, histologic tumor grade, tumor size, and tumor depth had little influence on the cumulative probability of local recurrence. The authors concluded that local management should be based on presentation status and surgical margins rather than other, previously acknowledged factors. Cancer 2012. © 2012 American Cancer Society.

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