Professor Cancer Institute (WIA) Chennai, Tamil Nadu, India
Objective: Background
Extremity soft tissue sarcomas (ESTS) comprise a collection of rare mesenchymal malignancies that account for 1% of all adult malignancies1. It is associated with limited experience due to their uncommon nature, extensive variability in clinical and histopathological presentation.2
AIM To analyse the oncological outcomes in patients of soft tissue sarcoma To assess the factors affecting OS and DFS in extremity soft tissue sarcoma.
Methods: Retrospectively data was collected from patient case records who received treatment between 2000-2020 on extremity soft tissue sarcomas. Among the study population, there was male preponderance 232(53.7%) and females were 200(46.3%). With the mean age of 40years, patients below 40years were 209(48.4%) and above 40years were 223(51.6%). Among more than 20 histological type, most common type among the study population were spindle cell sarcoma(40.5%),followed by synovial sarcoma(23.4%). The most commonly tumour locations were noted in thigh (39.4%),followed by leg (16.7%).In the upper extremity most common site was arm(9.5%). Based on size of lesions,43.1%were < 5cm and 2.5% were >20cm.Most of the patients were Non-Metastatic at presentation(94.2%),while metastasis was noted in about 5.8%., Chemotherapy was given as neoadjuvant treatment in (12.5%). Among the analysed patients 175(40.5%), received adjuvant chemotherapy. Surgery was performed as Amputation(21.3%)or Limb salvage surgery(78.7%) in which margins were negative in 81.5% and positive in 17.4%.PORT was received in 190 patients(57.8%).
Results: The mean overall survival was 115.4months (95%CI 103.1-127.63).The 5year overall survival was 62%.On univariate analysis significant p-value was observed with age(p=0.002),histology(p=0.021),adjuvant chemotherapy(p=0.005),PORT(p=0.001).Age at diagnosis, histology is a prognostic factor affecting the over-all survival. The response to chemotherapy is a strong prognostic factor to outcome.Multivariate analysis using cox regression, histology (p=0.015),surgery (p=0.001) adjuvant chemotherapy (p=0.023) had shown improvement on overall survival rates.The mean disease free survival was 30.7months(95%CI 22.9-38.5),with 3year DFS was 22%. Most of the recurrences noted were locally(71.8%) and systemic were 28.2%
Conclusion: Overall survival is being significantly affected in patients receiving adjuvant chemotherapy suggesting good oncological results can be achieved by using a, suitable adjuvant therapies. Benefits of adjuvant therapy include, sterilizing tumour margins and treating metastatic disease.The histological type may play a role during decision making on whether to offer chemotherapy, since some types are felt to be more chemo-sensitive than others.
