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      Improved prognosis in soft-tissue sarcoma of extremity and trunk wall : Comparison of patients diagnosed during 1998–2001 and 2005–2010 in Finland

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          Abstract

          Background and purpose — Soft-tissue sarcoma (STS) is rare, with challenging individualized treatment, so diagnostics and treatment should be centralized. Historical controls are sometimes used for investigation of whether new diagnostic or therapeutic tools affect patient outcome. However, as yet unknown factors may affect the outcome. We investigated prognostic factors and prognosis in 2 nationwide cohorts of patients diagnosed with a local STS during the periods 1998–2001 and 2005–2010, with special interest in finding factors lying behind possible improvement of prognosis.

          Patients and methods — 2 cohorts of patients with STS of the extremities or trunk diagnosed during the periods 1998–2001 and 2005–2010 were retrieved from the nationwide Finnish Cancer Registry. Detailed information was gathered from patient files.

          Results — Compared to first cohort, a larger proportion of patients with inadequate surgery in the second cohort received radiation therapy, and both the local control rate and the sarcoma-specific survival rate improved in the second cohort. For sarcoma-specific survival, cohort (HR =0.6, 95% CI: 0.5–0.9), age, depth, grade, and margin were significant factors in multivariate analysis. For local control, cohort (HR =0.6, 95% CI: 0.5–0.9), age, and margin were significant in multivariate analysis.

          Interpretation — Known prognostic factors including type of treatment did not entirely explain the secular trend of continuous improvement in prognosis in STS. This illustrates the danger of using historical controls for investigation of whether new diagnostic or therapeutic tools have an effect on patient outcome.

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          Most cited references 6

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          Data quality and quality control of a population-based cancer registry. Experience in Finland.

          Cancer registries should pay great attention to the quality of their data, both in terms of completeness (all cancer patients in the population are registered) and accuracy (data on individual cancer patients must be correct). In addition to technical measures in the data processing, different types of checks and comparisons should be routine practice. Active research policy and ambitious, research-oriented staff with competence in medicine, biostatistics and computer science are essential in terms of maintaining good data quality.
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            The effect of the Anatomic setting on the results of surgical procedures for soft parts sarcoma of the thigh.

            The results of surgical treatment in 40 patients with a soft tissue sarcoma of the thigh were analyzed to determine the influence of the anatomic setting on the effectiveness of the procedure. The anatomic setting, based on functional anatomic compartments, was defined as either intra- or extracompartmental. The lesions were graded for aggressiveness as either high or low. The lesions were staged by biologic aggressiveness, anatomic setting, and metastases. The procedures, whether amputations or local resections, were classified by the relationship of the surgical margin to the pseudocapsule and reactive zone about the lesion as marginal, wide, or radical. Marginal procedures were done four times with two recurrences. Wide margins were achieved 12 times. When done for low grade lesions, there were no recurrences (0/2), but when done for high grade lesions, the recurrence rate was 30% (3/10). Radical margins were obtained 24 times. There was one recurrence after a radical procedure. Recurrence rates did not depend upon whether the procedure was a resection or amputation but upon the margin achieved. The anatomic setting of the lesion was intracompartmental in 13 cases and extracompartmental in 27. Not only were surgically adequate margins achieved more often for intracompartmental lesions (10/13) than for extracompartmental lesions (17/27), but there was a significant difference in the manner required to achieve an adequate margin. Although 9 of the 13 intracompartmental lesions were amenable to nonablative resection, only 3 of 27 extracompartmental lesions were resectable. The margin required for local control (wide vs. radical) was dictated by the biologic aggressiveness (grade) of the lesion. How the necessary margin was most satisfactorily achieved (resection vs. amputation) was determined by the anatomic setting (intra- vs. extracompartmental).
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              Impact of the smallest surgical margin on local control in soft tissue sarcoma.

              The aim was to review a single-institution experience of a prospective treatment protocol for soft tissue sarcoma of the extremity and trunk wall, with particular focus on the smallest surgical margin leading to local control. The study included 270 patients who had surgery for soft tissue sarcoma at Helsinki University Central Hospital between 1987 and 1997. Resection margins were measured prospectively from tumour specimens. Radiotherapy was administered if the smallest margin measured less than 2.5 cm, irrespective of tumour grade. With a median follow-up of 6.6 years, the 5-year local control rate was 76.4 per cent. On multivariable analysis, the smallest surgical margin around the sarcoma (after radiotherapy) was prognostic for local control. A margin of at least 2.5 cm was associated with a local recurrence-free rate of 89.2 per cent at 5 years. Tumour size, depth or grade and patient's age had no independent prognostic effect on local control. Surgical margin had independent prognostic value for local control. A surgical margin of 2-3 cm provided reasonable local control of soft tissue sarcoma, even without radiotherapy. Radiotherapy is recommended for smaller margins, irrespective of tumour grade. 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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                Author and article information

                Journal
                Acta Orthop
                Acta Orthop
                IORT
                Acta Orthopaedica
                Taylor & Francis
                1745-3674
                1745-3682
                February 2017
                17 June 2016
                : 88
                : 1
                : 116-120
                Affiliations
                [a ]Department of Pathology, University of Helsinki, and HUSLAB, Helsinki University Hospital
                [b ]Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki
                [c ]Department of Oncology, Oulu University Hospital, Oulu
                [d ]Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
                Author notes
                Article
                iort-88-116
                10.1080/17453674.2016.1196429
                5251257
                27321676
                © 2016 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License ( https://creativecommons.org/licenses/by-nc/3.0)

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                Tumor

                Orthopedics

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