Impact of resection margin on outcome in soft-tissue sarcomas of the extremities treated with limb-sparing surgery and postoperative radiotherapy.

Autor: Chen CC; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan. ms8614@gmail.com.; College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan. ms8614@gmail.com.; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan. ms8614@gmail.com., Wu YY; Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist, Keelung City, 204, Taiwan.; College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan., Kao JT; Hejiang Orthopedic Clinic, No. 200, Zhongzheng E. Rd., Zhubei City, Hsinchu County, 302, Taiwan., Chang CH; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.; College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan.; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan., Huang SC; Department of Anatomic Pathology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.; College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan., Shih HN; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.; College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan.; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.
Jazyk: angličtina
Zdroj: World journal of surgical oncology [World J Surg Oncol] 2024 Apr 26; Vol. 22 (1), pp. 113. Date of Electronic Publication: 2024 Apr 26.
DOI: 10.1186/s12957-024-03380-y
Abstrakt: Background: The standard curative treatments for extremity soft tissue sarcoma (ESTS) include surgical resection with negative margins and perioperative radiotherapy. However, the optimal resection margin remains controversial. This study aimed to evaluate the outcomes in ESTS between microscopically positive margin (R1) and microscopically negative margin (R0) according to the Union for International Cancer Control (UICC) (R + 1 mm) classification.
Methods: Medical records of patients with localized ESTS who underwent primary limb-sparing surgery and postoperative radiotherapy between 2004 and 2015 were retrospectively reviewed. Patients were followed for at least 5 years or till local or distant recurrence was diagnosed during follow-up. Outcomes were local and distal recurrences and survival.
Results: A total of 52 patients were included in this study, in which 17 underwent R0 resection and 35 underwent R1 resection. No significant differences were observed in rates of local recurrence (11.4% vs. 35.3%, p = 0.062) or distant recurrence (40.0% vs. 41.18%, p = 0.935) between R0 and R1 groups. Multivariate analysis showed that distant recurrences was associated with a Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade (Grade III vs. I, adjusted hazard ratio (aHR): 12.53, 95% confidence interval (CI): 2.67-58.88, p = 0.001) and tumor location (lower vs. upper extremity, aHR: 0.23, 95% CI: 0.07-0.7, p = 0.01). Kaplan-Meier plots showed no significant differences in local (p = 0.444) or distant recurrent-free survival (p = 0.161) between R0 and R1 groups.
Conclusions: R1 margins, when complemented by radiotherapy, did not significantly alter outcomes of ESTS as R0 margins. Further studies with more histopathological types and larger cohorts are necessary to highlight the path forward.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: