Connective Tissue Oncology Society

2001 CTOS Annual Meeting—Oral Presentations

MARGIN WIDTH HAS PROGNOSTIC SIGNIFICANCE FOR EXTREMITY / TRUNCAL SARCOMA
Mark D. McKee, Dong Feng Liu, Deborah Driscoll, John J. Brooks, John F. Gibbs, William G. Kraybill
Roswell Park Cancer Institute

OBJECTIVE: Following resection of soft tissue sarcoma (STS), the presence of positive margins is associated with local recurrence and inconsistently reported to predict distant failure or shorter survival. Margin width is not emphasized in treatment planning or outcome analyses. We examined the prognosis of patients with wide margins (10+ mm), close margins (1-9 mm), and positive margins (0 mm).

METHODS: Patients undergoing resection of primary extremity / truncal sarcoma were evaluated for clinico-pathological features predicting outcome via retrospective review of charts and tumor specimens. Only patietnts with residual tumor available for pathologic review were included.

RESULTS: Among 111 patients, tumors were predominantly intermediate to high grade (95), larger or equal to 5 cm in size (84), and deep (90). Treatment included wide excision or amputation for 110. High risk patients with positive or negative margins received adjuvant radiation (RT) (42 patients) and/or adjuvant chemotherapy (CT) (37 patients). Margin status: The margin width was 10+ mm in 53 patients (48%), 1-9 mm in 45 patients (40%), and 0mm in 13 patients (12%). Margins of 0 mm and 1-9 mm were more common among tumors of larger size (p=.008), and deep location (p=.01). More grade 1 tumors had 0 mm margins, and more grade 2 tumors had 10+ mm margins (p=.02). Age, gender, stage, site, necrosis, mitotic rate, resection type, and RT were similar among groups. Multivariate analysis: In a model including age, gender, grade, size, depth, stage, histology, tumor location, type of resection, RT, CT, and margin status, independent predictors of poor disease-free survival included higher grade (p=.009), larger size (p=.003), and decreased margin width (p=.007). Independent predictors of poor overall survival included higher grade (p=.001), larger size (p=.002), and deep location (p=.05).

Margin (mm)	N	+RT	Local recurrence.	Distant recurrence	5 yr DFS (p=.003)	5 yr OS (p=.17)
10+	53	20	9 (17%)	15 (28%)	60%	72%
1-9	45	17	15 (33%)	28 (62%)	29%	55%
0	13	5	5 (38%)	5 (38%)	25%	37%
All	111	42	29 (26%)	48 (43%)	44%	61%

CONCLUSION: Wide negative margins (10+ mm) should be the goal of extremity / truncal STS resection. Local recurrence, distant recurrence, and disease-free survivals are similar for patients with close (1-9 mm) and positive (0 mm) margins. The surgical margin width should be considered for treatment planning and when reporting outcomes.