Critical study of resection margins in adult soft-tissue sarcoma surgery

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• 作者：F. Lintz^a ; A. Moreau^b ; G.-A. Odri^a ; ^c ; D. Waast^a ; O. Maillard^d ; F. Gouin^a ; ^c ; ^{francois.gouin@chu-nantes.fr}
• 关键词：Soft-tissue sarcoma ; Resection margins ; Prognostic factors ; Survival ; Local recurrence ; Metastasis
• 刊名：Orthopaedics Traumatology ; Surgery Research
• 出版年：2012
• 期刊代码：P108_18770568
• 类别：med
• 出版时间：June, 2012
• 卷：98
• 期：4_supp_S
• 页码：S9-S18
• 文件大小：1899 K

摘要

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Summary

Introduction

Resection margins constitute a recognized risk factor for local recurrence, but their impact on survival is less clear.

Hypothesis

Infiltrative proliferation and satellite nodules are prognostic factors for local and systemic aggressiveness.

Type of study

Retrospective cohort study.

Patients and methods

In 105聽patients under curative treatment, resection quality was assessed on UICC criteria (R0/R1) and on a modified version (R0 M/R1 M) taking account of proliferation contours and satellite nodules for narrow margins (< 1 mm). Uni- and multi-variate analysis was performed, and Kaplan-Meier survival curves were compared on log-rank.

Results

Mean 5-year local recurrence-free survival (LRFS) was 0.64 [0.52-0.76] after R1 surgery, 0.9 [0.85-0.95] after R0, 0.64 [0.519-0.751] after R1 M and 0.92 [0.87-0.96] after R0 M. Resection type according to R classification correlated with disease-free survival (DFS) (P = 0.028), but not with metastasis-free survival (MFS) (P = 0.156). Resection type according to RM classification correlated with DFS and MFS. Multivariate analysis disclosed correlations between LRFS rate and RM resection type (HR 6.77 [1.78-25.7], P = 0.005), DFS rate and RM resection type (HR 2.83 [1.47-5.43], P = 0.001) and grade (HR = 3.17 [1.38-7.27], P = 0.003), and MFS and grade (HR = 3.96 [1.50-10.5], P = 0.006).

Discussion

The microscopic aspect of the proliferation contours and presence of satellite nodules were confirmed as prognostic factors for local and systemic aggressiveness. They impact both disease-free survival and metastasis-free survival in case of margins less than 1 mm. Their systematic consideration may help identify patients with elevated systemic risk.

Level of evidence

IV.