Recurrence and Mortality after Surgical Treatment of Soft Tissue Sarcomas
AbstractBackground: The recurrence rate after soft tissue sarcoma (STS) treatment ranges between 20-25 % ,and usually occurs within 2-3 years after primary surgery. In Africa, many of the patients present late, access to adjuvant therapy is not guaranteed either. The basis of this study was to establish patterns and factors affecting recurrence and mortality after surgical treatment at a national referral medical facility.
Methods: A five and a half years retrospective study between January 2003 and June 2007 and a six months prospective follow-up arm between July 2008 and March 2009.
Data reviewed from all eligible surgically treated patients were demographic variables, duration of symptoms, anatomical distribution, investigations, adjuvant therapy, tumour type, size, grade and stage and surgical margins status. The outcome variables were tumour recurrence and death.
Results: Mean age was 32.52+18.17 years. The male/female sex ratio was 0.97:1. The mean duration of symptoms was 10.87+18.75 months. The extremities had the most number of cases (62%). Fibrosarcoma was the most common histological type (36.0%) and the mean tumour size was 13.0 +7.36 cm. Most (44.7%) patients presented with high grade tumours and 78.0 % of the patients presented with a recurrence. Most of the recurrences (71.7%) occurred within the first year of treatment.
Failure to get adjuvant therapy (p<0.001), tumour size >5cm (p=0.02), advanced stage (III and IV) (p<0.001), and positive microscopic margins (p<0.001) were adverse prognostic factors for recurrence. Presentation with a recurrent tumour (p<0.027), failure to receive adjuvant therapy (p<0.001), advanced stages (III and IV) (p<0.001), positive microscopic margins (p<0.001), and high grade tumours (p<0.001), were predictors for death.
Conclusions:Advanced stages of STS, higher histological grades, positive microscopic surgical margins, and failure to receive adjuvant treatment influenced both recurrence and mortality after surgical treatment. Better outcome results from surgical treatment of soft tissue sarcomas may be achieved if efforts to treat them earlier were to be a reality.
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