Chigusa Sawamura

Guidelines suggest that followup for low-grade soft tissue sarcomas should be every 3 to 6 months for 2 to 3 years and then annually, and for high-grade sarcomas every 3 to 6 months for 2 to 5 years, then every 6 months for the next 2 years, and then annually. However, there is only very limited evidence to support these strategies. In a population of patients treated surgically for soft tissue sarcomas, we evaluated the (1) timing of diagnosis of local recurrences after sarcoma excision; (2) timing of diagnosis of distant metastases; and (3) the difference in those parameters based on tumor size and grade. Patients diagnosed with soft tissue sarcomas and who underwent surgical excision between 1978 and 2008 were retrospectively reviewed. Age, histologic diagnosis, Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade, tumor location, and size were reviewed at a mean of 6 years (range, 1 month to 30 years). We met with patients every 3 months for 5 years, every 6 months for 10 years, and then annually until 15 years after surgery. Eight hundred sixty-seven patients with a median age at diagnosis of 52 years were eligible for analysis. The incidence of local recurrence and metastases was calculated for every 2-year period and presented per 1000 person-years. Ninety-eight patients (11%) developed local recurrence at a median time of 19 months; 90% of patients who had local recurrences had them within 7.1 years, and 95% occurred by 8.6 years. One hundred ninety-eight patients (23%) developed distant metastases at a median time of 12 months; 90% of patients who developed metastases developed them by 4.2 years and 95% did so by 7.3 years. High-grade tumors had a higher incidence of local recurrence and metastases in first 2 years, whereas low-grade tumors recurred at a constant rate throughout the followup period. Followup beyond 10 years does not yield a sufficient number of local recurrences or metastases to warrant further monitoring. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Lymph node metastases in patients with soft tissue sarcomas are rare and these metastases are frequently associated with certain histologic subtypes. The survival is believed to be poor if lymph node metastases occur and the potential benefit of lymphadenectomy is unclear. We determined whether lymph node metastases affect overall survival with regard to the status of lymphadenectomy, histologic subtypes, isolated or systemic metastasis, and the timing of presentation of lymph node metastases. We retrospectively reviewed all 871 patients diagnosed with soft tissue sarcomas between 1983 and 2008 to determine whether they had lymph node metastases at diagnosis or subsequently and whether they had lymphadenectomy for treatment. Overall survival was assessed and the effect of prognostic variables was examined by a log rank test. Forty-nine of the 871 patients (6%) had lymph node metastases. The estimated 5-year survival rate for the group of 49 patients with lymph node metastases was 27%. Those who had lymphadenectomy had better survival at 1.5 years although there was no difference between those who did not undergo lymphadenectomy at 5 years. Patients with nonrhabdomyosarcoma had better overall survival than patients with rhabdomyosarcoma. Timing of development of lymph node involvement and whether lymph node metastases were an isolated site did not affect the overall survival. Overall survival of patients with lymph node metastases was related to histologic subtypes and patients with nonrhabdomyosarcoma had better survival than those with rhabdomyosarcoma. Resection of the metastatic lymph node did not improve long-term survival of patients with soft tissue sarcomas. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Tumors at various depths, it is unclear what factors influence recurrence of deep, high-grade sarcomas. Questions/purposes We therefore determined whether possible risk factors (tumor size, location, histologic subtype, unplanned excision, local recurrence at presentation, metastasis at diagnosis, surgical procedure, surgical margin, and adjuvant treatments) influenced local recurrence of deep, high-grade, soft-tissue sarcomas. Patients and Methods We retrospectively reviewed 433 patients with deep, high-grade, soft-tissue sarcomas surgically treated between 1985 and 2005. For each patient, we reviewed tumor size, location, histologic subtype, unplanned excision, local recurrence at presentation, metastasis at diagnosis, surgical procedure, surgical margin, and adjuvant treatments and determined the effect of each prognostic variable on local recurrence. The minimum followup was 1 month (median, 51 months; range, 1-305 months). Results Forty-seven patients had local recurrence at a median of 10.7 months. Local recurrence at presentation, metastasis at diagnosis, and positive margins independently predicted local recurrence. No other factors independently predicted local recurrence. Conclusions Unplanned excisions did not increase the rate of local recurrence of deep, high-grade, soft-tissue sarcomas if treated appropriately. Aggressiveness of tumor represented by metastasis or local recurrence at presentation may be a risk for local recurrence. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence....