The impact of unplanned excisions of truncal/extremity soft tissue sarcomas: A multi-institutional propensity score analysis from the US Sarcoma Collaborative. J Surg Oncol 2019 Sep;120(3):332-339
Date
06/07/2019Pubmed ID
31172536DOI
10.1002/jso.25521Scopus ID
2-s2.0-85070213385 (requires institutional sign-in at Scopus site) 22 CitationsAbstract
OBJECTIVE: Our aim was to compare outcomes in patients who underwent unplanned excisions (UE) of soft-tissue sarcomas (STS) against patients with planned excisions (PE).
METHODS: The retrospective 7-institution US Sarcoma Collaborative database was used. Patients with curative-intent resection of truncal/extremity STS between 2000 and 2016 were included. Propensity score weighting analysis (PSWA) was performed. Endpoints were locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-specific survival (DSS).
RESULTS: One thousand five hundred and ninety-six patients were included. Eighty-two percent (n = 1315) underwent PE and 18% (n = 281) underwent UE. Compared with PE, patients with UE were younger with smaller tumors with similar tumor grade. Unmatched analysis revealed PE was associated with worse DMFS (hazard ratio [HR] 1.95, P = .009) and DSS (HR 1.78, P = .039), but not LRFS compared with UE. On PSWA, UE had earlier LRFS (3-year LRFS: 80.5% vs 89.8%, P = .039), but not DMFS or DSS. By grade, patients with high-grade tumors and UE had worse LRFS (1-year LRFS: 90% vs 94%, P = .015), but similar DMFS and DSS compared with PE. In low-grade patients, UE and PE had similar LRFS, DMFS, or DSS.
CONCLUSIONS: UE of STS is not associated with worse prognosis compared to PE, though UE is associated with earlier locoregional recurrence in patients with high-grade tumors. Multimodality therapy is needed to achieve improved outcomes in these patients.
Author List
Zaidi MY, Ethun CG, Liu Y, Poultsides G, Howard JH, Mogal H, Tseng J, Votanopoulos K, Fields RC, Cardona KMESH terms used to index this publication - Major topics in bold
Cohort StudiesCytoreduction Surgical Procedures
Extremities
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Propensity Score
Retrospective Studies
Sarcoma
Torso
Treatment Outcome