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Why Do Patients with Low-Grade Soft Tissue Sarcoma Die?

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

The patterns of failure and mechanisms of sarcoma-specific death are poorly characterized among the minority of patients with low-grade soft tissue sarcoma (STS) who succumb to disease.

Methods

Between 1982 and 2006, 2,041 patients aged ≥16 years with low-grade STS of all sites were treated with curative intent and prospectively followed at a single institution.

Results

Among this cohort, 181 (9%) died from disease (DOD). Overall, 105 patients (58%) died from locally recurrent disease (DOLR), and 59 (32%) died from distant disease (DODR). In 17 patients (9%), the mechanism of sarcoma-related death could not be verified. DOD occurred at a median of 62 months, while median disease-specific survival for the entire cohort was not reached. Median follow-up was 66 months (range 2–431 months). On multivariate analysis, DOD was associated with site, size, and less than R0 resection. For DOLR, site, size, positive margins, liposarcoma histology, and local recurrence (by definition) were significant factors. For DODR, site, histology, and positive margins were not significant factors, while size and local recurrence were. Of DOLR, 80% were retroperitoneal, 68% were liposarcoma, and only 2% were extremity. Conversely, of DODR, extremity (47%) and trunk (18%) were the most common sites, but histology was more variable [liposarcoma 35%, malignant fibrous histiocytoma (MFH) 20%, fibrosarcoma 12%, extraskeletal myxoid chondrosarcoma 10%]. High-grade recurrence rates were comparable between DOLR (27%) and DODR (25%).

Conclusion

Among patients with low-grade STS, DOD occurs in approximately 9% of patients. Nonextremity site, larger size, and less than R0 resection are the most important risk factors for DOD, and distinct patterns of recurrence and death are predicted by primary tumor site.

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Acknowledgements

This work was supported by Soft Tissue Sarcoma Program Project grant P01 CA 047179 (L.X.Q., R.G.M., S.S., and M.F.B.)

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 410 E. 68th Street, New York, NY, 10065, USA

    Robert J. Canter MD, Cristina R. Ferrone MD & Samuel Singer MD

  2. Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Li-Xuan Qin PhD

  3. Department of Medicine, Melanoma-Sarcoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Robert G. Maki MD, PhD

  4. Department of Surgery, Benno C. Schmidt Chair in Clinical Oncology, Memorial Sloan-Kettering Cancer Center, 410 E. 68th Street, New York, NY, 10065, USA

    Murray F. Brennan MD

Authors
  1. Robert J. Canter MD
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  2. Li-Xuan Qin PhD
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  3. Cristina R. Ferrone MD
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  4. Robert G. Maki MD, PhD
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  5. Samuel Singer MD
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  6. Murray F. Brennan MD
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Corresponding author

Correspondence to Murray F. Brennan MD.

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Canter, R.J., Qin, LX., Ferrone, C.R. et al. Why Do Patients with Low-Grade Soft Tissue Sarcoma Die?. Ann Surg Oncol 15, 3550–3560 (2008). https://doi.org/10.1245/s10434-008-0163-0

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  • DOI: https://doi.org/10.1245/s10434-008-0163-0

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