Connective Tissue Oncology Society

2001 CTOS Annual Meeting Posters— Surgery

EXCISIONAL BIOPSY PRIOR TO WIDE RESECTION OF EXTREMITY SARCOMA IS ASSOCIATED WITH IMPROVED OUTCOME
Mark D. McKee¹, Brian P. Whooley², Deborah Driscoll¹, John F. Gibbs¹, William G. Kraybill¹
¹Roswell Park Cancer Institute, ²Saint Vincent's Hospital and Medical Center

OBJECTIVE: Needle or incisional biopsies are preferred over excisional biopsy for suspected sarcoma since they are limited procedures, they minimize the amount of surrounding tissue exposed to tumor, and the sites are easily encompassed at the time of wide resection. Sarcoma treatment by definitive wide resection after excisional biopsy (re-resection) has been reported to independently predict freedom from distant metastases and improved overall survival. We evaluated patients undergoing surgery for sarcoma to determine the influence of excisional biopsy and re-resection on patient outcome.

METHODS: Clinical factors, pathologic factors, and outcome were determined for 202 patients who were surgically treated for extremity soft tissue sarcoma between 1982 and 1998. Outcomes were measured for patients undergoing definitive surgery after excisional biopsy (re-resection) or definitive surgery after incisional, needle, or no biopsy (single resection).

RESULTS: Tumors were predominantly high-grade (148/196), larger or equal to 5cm in size (142/200), deep (166/202), and located on the lower limb (145/202). Treatment included wide local excision, compartment resection, or amputation. Final resection margins were negative for 190/202. Patient / tumor factors: Patients who underwent re-resection were more likely to have small tumors, superficial tumors, upper extremity tumors, and be of younger age. Gender, duration of symptoms, tumor grade, histology, and resection margin were no different between groups. Outcome: Recurrence and survival by group are shown in the table below. Margin status after excisional biopsy did not influence patient outcome. Multivariate analysis: Factors associated with improved overall survival (OS) by univariate analysis included young patient age (p<.001), low tumor grade (p<.001), small tumor size (p<.01), superficial location (p<.05), and re-resection (p<.001). By multivariate analysis, improved disease-free survival (DFS) was predicted by low tumor grade (p<.01) and re-resection (p<.05). Improved OS was predicted by low tumor grade (p<.01) and re-resection (p<.001).

	N	LR (p=NS)	DR (p<.001)	5 yr DFS (p<.001)	5 yr OS (p<.001)
Re-resection	109	17 (16%)	26 (24%)	60%	72%
Single resection	93	18 (19%)	43 (46%)	26%	48%

CONCLUSION: Re-resection following excisional biopsy for extremity sarcoma independently predicted freedom from distant recurrence and improved survival. These results were unexpected, and could not be entirely explained by differences in clinico-pathologic features between the groups. The biologic reasons for improved outcome among patients undergoing re-resection are not clear.