Journal of Clinical Oncology, Vol 15, 2832-2839, Copyright © 1997 by American Society of Clinical Oncology
Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management
MJ Heslin, JJ Lewis, E Nadler, E Newman, JM Woodruff, ES Casper, D Leung and MF Brennan
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
PURPOSE: Retroperitoneal soft tissue sarcomas are rare tumors. Studies
characterizing long-term follow-up and patterns of recurrence are limited.
The purpose of this analysis is to identify patterns of recurrence and
prognostic factors associated with long-term survival after resection of
retroperitoneal soft tissue sarcomas. METHODS: Between July 1, 1982, and
June 30, 1990, 198 adult patients were identified from our prospective soft
tissue sarcoma database carrying the diagnosis of retroperitoneal soft
tissue sarcoma who were eligible for > or = 5 years of follow-up. Of
these, 48 patients (25%) were documented to be alive > or = 5 years from
the time of operation. Statistical analysis was by log-rank or Wilcoxon
test for univariate analysis. Multivariate analysis was by the Cox model.
RESULTS: The recurrence rate during the follow-up period was approximately
5% per year from the time of initial operation. Of the patients who were
disease-free for > or = 5 years from initial surgery, 40% recurred by 10
years. Radiation therapy was the only factor significant (P = .02) for a
reduction in the risk of local recurrence. Age < or = 50 years and
high-grade tumors were significant factors (P = .003 and .009,
respectively) for an increased risk of distant metastasis. Incomplete gross
resection was the only factor significant for an increased risk of tumor
mortality (P = .003). CONCLUSION: Complete surgical resection at the time
of primary presentation is likely to afford the best chance for long-term
survival. With long-term follow-up, it is clear that recurrence will
continue to occur, and a 5-year disease-free interval is not a cure.
Patients with an incomplete initial resection, age less than 50 years, and
high-grade tumors are candidates for investigational adjuvant therapy.
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