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Influence of Size, Invasiveness, and Grade on Outcome

Bhaskar N. Rao, MD; Victor M. Santana, MD; David Parham, MD; Charles B. Pratt, MD; Irving D. Fleming, MD; Melissa Hudson, MD; James Fontanesi, MD; Paul Philippe, MD; Michael J. Schell, PhD

Arch Surg. 1991;126(12):1490-1495.

Abstract
• Surgery alone or supplemental radiation is effective in local control in a majority of patients with nonrhabdomyosarcoma of the soft tissue. To determine the factors influencing subsequent survival, a retrospective review of 64 children with nonrhabdomyosarcoma of the soft tissue of the extremities was performed. Using the American Joint Committee on Cancer staging system, 32 patients had noninvasive T1 lesions, and 31 of these patients survived disease free. Twenty-two patients had lesions that were smaller than 5 cm; 19 of these lesions were grade G1-2. All 22 patients survived. Ten patients had tumors that were 5 cm or larger, and all were G1-2; nine of these patients survived. Thirty-two patients had invasive (T2) lesions; seven of these lesions were smaller than 5 cm, but four were G3. Only one patient survived. Eighteen (72%) of 25 lesions that were 5 cm or larger were G3. Fifteen (83%) of these 18 patients underwent relapse, with 12 patients dying of the disease. Important prognostic factors included G3 lesions, with a 72% (18 of 25 patients) failure rate, and T2 lesions, which were generally larger than 5 cm, of higher grade, and underwent relapse more frequently than T1 lesions. These patients with histologic G3 and T2 lesions may benefit from chemotherapy.

(Arch Surg. 1991;126:1490-1495)

Author Affiliations
From the Departments of Surgery (Drs Rao, Fleming, and Philippe), Hematology-Oncology (Drs Santana, Pratt, and Hudson), Pathology (Dr Parham), Radiation Oncology (Dr Fontanesi), and Biostatistics (Dr Schell), St Jude Children's Research Hospital, Memphis, Tenn, and the Departments of Surgery (Drs Rao, Fleming, and Philippe), Pediatrics (Drs Santana, Pratt, and Hudson), Pathology (Dr Parham), and Radiation Oncology (Dr Fontanesi), the University of Tennessee, Memphis.

Footnotes
Accepted for publication September 1, 1991.

Presented at the 44th Annual Cancer Symposium of the Society of Surgical Oncology, Orlando, Fla, March 26, 1991.

Reprint requests to Department of Surgical Oncology, St Jude Children's Research Hospital, 332 N Lauderdale, Memphis, TN 38101 (Dr Rao).

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