Prognostic significance of a positive microscopic margin in high-risk extremity soft tissue sarcoma: Implications for management Journal Article
| Authors: | Heslin, M. J.; Woodruff, J.; Brennan, M. F. |
| Article Title: | Prognostic significance of a positive microscopic margin in high-risk extremity soft tissue sarcoma: Implications for management |
| Abstract: | Purpose: A positive microscopic margin (PMM) is a significant prognostic variable and leads to local recurrence (LR) in high-grade soft tissue sarcoma (STS) patients. Its effect on the rate of distant metastasis (DM) and tumor mortality (TM) remains controversial. Patients and Methods: One hundred sixty-eight primary, high-risk (high-grade, deep, ≥ 5 cm) extremity STS patients were identified from our data base, of which 42 had a PMM. Limb- sparing surgery (LSS) was the primary surgical therapy in 144 patients; 24 received amputation (AMP). Statistical analysis was by log-rank test and Cox model. Significance was defined as a P value less than .05. Results: A PMM was a significant negative prognostic factor for both DM and TM (P = .002 and .002, respectively). However, those patients who received LSS with 28% PMMs showed no significant difference in the rate of DM or TM compared with patients who received AMP with only 8% PMMs (log-rank, P = .057 and .28, respectively). A PMM was significantly associated with ≥ 1,000 mL blood loss and more than 3 hours of operating time (P < .006 and .001, respectively). Conclusion: The strong statistical significance that relates a PMM to DM and TM in high-risk STS of the extremity is likely related to biologically aggressive tumors and LSS. Residual microscopic disease is not a guarantee of LR. The main problem in this group of patients is not LR, but DM and subsequent death. Therefore, to increase a disability with further surgery or amputate a patient's limb without clear evidence of LR in this group at high risk for distant recurrence is not recommended. |
| Keywords: | adult; human tissue; aged; human cell; major clinical study; histopathology; cancer recurrence; recurrence risk; surgical approach; cancer mortality; sarcoma; cancer cytodiagnosis; neoplasm metastasis; amputation; soft tissue sarcoma; extremities; metastasis potential; high risk population; soft tissue neoplasms; humans; prognosis; human; male; female; priority journal; article |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 14 |
| Issue: | 2 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 1996-02-01 |
| Start Page: | 473 |
| End Page: | 478 |
| Language: | English |
| PUBMED: | 8636760 |
| PROVIDER: | scopus |
| DOI: | 10.1200/JCO.1996.14.2.473 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 22 November 2017 -- Source: Scopus |
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