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Multifactorial Analysis of Long-term Follow-up (More Than 5 Years) of Primary Extremity Sarcoma
Jonathan J. Lewis, MD, PhD;
Denis Leung, PhD;
Ephraim S. Casper, MD;
James Woodruff, MD;
Steven I. Hajdu, MD;
Murray F. Brennan, MD
Arch Surg. 1999;134:190-194.
Background The majority of survival studies in patients with extremity soft tissue sarcoma have focused on early recurrence and mortality. There are few data addressing long-term follow-up and survival.
Objective To analyze survival and recurrence in patients with extremity soft tissue sarcoma who survive for more than 5 years.
Methods Patients who underwent treatment for primary tumors (July 1982 to July 1994) and were followed up for more than 5 years were the subject of study. Disease-specific and disease-free survival were determined actuarially. Significance was evaluated using log-rank testing for univariate analysis and Cox model stepwise regression for multivariate analysis.
Results A total of 495 patients with primary extremity tumors were treated before July 1989 and eligible for 5-year follow-up. Of these, 282 have been followed up for more than 5 years (median follow-up, 84.4 months). Actuarial disease-specific survival of patients who survive for longer than 5 years was 79%±7% (±SEM) at 10 years, and of those who were metastasis free at 5 years was 91%±4% at 10 years. On univariate analysis, post–5-year disease-specific survival was influenced by positive microscopic margin and initial tumor size of 5 cm or greater. On multivariate analysis, post–5-year disease-specific survival was influenced only by positive margins.
Conclusions Based on these analyses, 21% of patients with primary extremity sarcoma who survive for 5 years will die of disease within 5 years. Even of those who are metastasis free at 5 years, 9% will die of disease within 5 years. In contrast to early mortality, tumor grade has no influence on post–5-year prognosis. Patients with positive microscopic margins are at risk for post–5-year disease-specific mortality and therefore require long-term follow-up and consideration for investigational therapy.
From the Departments of Surgery (Drs Lewis and Brennan), Biostatistics (Dr Leung), Medicine (Dr Casper), and Pathology (Drs Woodruff and Hajdu), Memorial Sloan-Kettering Cancer Center, New York, NY. Dr Hajdu is now with the Department of Pathology, North Shore University Hospital, Manhasset, NY.
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