Abstract
Introduction and Aims: The aim of surgeons including patients with soft tissue sarcoma is to gain local control of the tumor, to avoid the risk of local recurrence, and to avoid the compromise of the patient’s potential survival. The aim of the investigation was to assess the significance of the extent of surgical margin on the chance of death, metastasis and local recurrence in soft tissue sarcoma.
Method: Three hundred and twenty-four patients were reviewed. Surgical margin data was unavailable for 21, and of the remaining 303 patients, 10 patients had no residual tumor, margins were not defined for 24 patients and nine patients had radical resections. Wide margins were achieved for the remaining 260 patients. Fifty-four percent had surgical margins of under five millimetres. Cox Proportional Hazards Regression modelling was used to consider the impact of surgical margin with an overall survival, disease-free survival and metastasis-free survival. Results were expressed as survival rate ratios and graphics represented as model-based survival curves. All associations that were statistically significant, as well as any associations for which the rate ratios were 2.0 or greater, were reported. Follow-up ranged from 53 days to 187 months, with a median of 40 months.
Results: Overall survival time for the 279 patients with complete information was 124 months. There was a significant association between overall survival and extent of the surgical margin (chi-squared test statistic = 14.7, 8df, p = 0.043). There was a significantly higher death rate in patients who had a wide contaminated margin or a radical resection – indicating a likely poorer prognostic group. There was however no difference between any margin less than 20mm. With respect to disease relapse, there were 27 local recurrences among 279 patients. There were no local recurrences in the 44 patients who had margins of 20mm or greater, no residual tumor, radical resection or for whom margins were not defined. Therefore to permit stable statistical analysis, 24 local recurrences among 213 patients were reviewed. There was a significant association between the extent of surgical margin and disease-free survival (chi-squared test statistic = 9.5, 4df, p = 0.051). However, with respect to metastasis, there was no relationship between surgical margin and the development of metastatic disease (chi-squared test statistic = 8.5, 8 df, p = 0.383).
Conclusion: There is significant statistical evidence to suggest improved overall survival and also improved local recurrence survival with increasing width of surgical margins. There is however the confounding information that the rate of metastasis does not depend on the width of the surgical margin. The question of whether success in obtaining local control is significant in terms of overall metastasis and death remains unresolved in terms of our study.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
