LONG-TERM OUTCOME OF PATIENTS WITH T1 HIGH-GRADE EXTREMITY SOFT TISSUE SARCOMAS: IMPORTANCE OF LONG-TERM FOLLOW-UP

Fleming J, Berman R, Cheng S, Chen N, Hunt K, Feig B, Respondek P, Yasko A, Pollack A, Patel S, Burgess M, Papadopoulos N, Plager C, Zagars G, Benjamin R, Pollock R, Pisters P (The Sarcoma Center, The University of Texas M D Anderson Cancer Center, Houston, Texas, 77030)

Purpose: It has been suggested that patients with small (< 5 cm), high-grade extremity soft tissue sarcoma (STS) have an excellent overall prognosis and consequently may not require adjuvant therapies. We assessed the long-term event-free outcome in this group of patients.

Methods: A comprehensive review of all patients with extremity STS treated at a single tertiary care cancer hospital over a 9-year period (January 1984 to December 1992) was performed. The entire cohort of 711 patients was retrospectively staged based on G, T, N, and M status at presentation. Clinicopathologic prognostic factors, treatment data, and long-term outcome were evaluated in the subset of 111 patients identified as having AJCC stage IIB (T1a/b, G3/4,) disease.

Results: The median tumor size was 3.0 cm (range, 0.6 to 4.9 cm), and 55 tumors (50%) were deep in location. All patients underwent surgical resection, 68 (61%) received pre- or postoperative radiotherapy, and 32 (29%) received doxorubicin-based chemotherapy. The median follow-up was 76 months. Forty patients (36%) experienced 59 recurrences. First recurrences occurred at local, regional, and distant sites in 21, 5, and 14 patients, respectively. Among the 40 patients with recurrence, 6 patients (15%) experienced late (< 5 years post-treatment) recurrence. The 5-year actuarial local recurrence-free, distant recurrence-free, disease-free, and overall survival rates were 82%, 83%, 68%, and 83%, respectively. The presence of a microscopically positive surgical margin was an independent adverse prognostic factor for both local recurrence (RR=3.75; 95% CI, 1.25 to 11.25; P=0.02) and disease-free survival (RR=2.57; 95% CI, 1.33 to 4.98; P=0.005).

Conclusion: With long-term follow-up, event-free outcome for the subset of patients with T1 high-grade STS does not appear as favorable as has been reported by other investigators. Long-term follow-up appears important even among patients with ostensibly early stage, good prognosis extremity STS. Patients who undergo maximal surgical resection with microscopically positive margins represent a higher risk subset of T1 extremity STS patients. These patients may warrant consideration for adjuvant radiotherapy and possibly systemic therapy.