Journal of Clinical Oncology, Vol 15, 646-652, Copyright © 1997 by American Society of Clinical Oncology
Association of local recurrence with subsequent survival in extremity soft tissue sarcoma
JJ Lewis, D Leung, M Heslin, JM Woodruff and MF Brennan
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
PURPOSE: The aim of this study was to analyze local recurrence in a large
cohort of prospectively followed patients with primary extremity soft
tissue sarcoma. In particular, we analyzed the correlation of local
recurrence with subsequent metastasis and disease-specific survival.
PATIENTS AND METHODS: Patients who underwent treatment for primary
extremity soft tissue sarcoma from July 1982 through July 1995 at Memorial
Sloan-Kettering Cancer Center were the subject of this study. Local
recurrence, distant metastasis, and disease-specific survival were used as
end points of the study. The influence of local recurrence on subsequent
distant metastasis and disease-specific survival were examined using the
Cox proportional hazards model. RESULTS: We treated 911 patients, of whom
297 (33%) developed recurrent disease. Local recurrence occurred in 116
patients (13%), metastasis in 167 (18%), and synchronous local recurrence
and metastasis in 13 (2%). Of 116 patients who developed local recurrence,
38 subsequently developed metastasis and 34 died of disease. Metastasis
after local recurrence was predicted in patients with initial high-grade (P
= .005; risk = 3.5) or deep (P = .02; risk = 2.9) tumors. Tumor mortality
after local recurrence was predicted in patients with initial high-grade (P
= .007; risk = 3.7) or large (> 5 cm; P = .01; risk = 3.2) primary
tumors. DISCUSSION: These findings suggest that there is a strong
association of local recurrence with the development of subsequent
metastasis and tumor mortality, and that local recurrence is a poor
prognostic factor. It would seem prudent to consider patients who develop
local recurrence and have high-grade tumors as being at high risk for
systemic disease and therefore eligible for investigational adjuvant
systemic therapy.
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