Prognostic factors were evaluated in 109 soft tissue sarcomas of the extremities, walls of the trunk, head, and neck. All lesions were graded according to the systems proposed by the National Cancer Institute (NCI) and the French Federation of Cancer Centers (FNCLCC), and a correlation was found between tumor grade and prognosis. Univariate analysis selected the following variables as unfavorable prognostic factors: invasive tumor margins, extra-compartmental status, deep tumors, tumor diameters over 5 cm, inadequate excision, presence of necrosis, high mitotic count, histologically undifferentiated tumors, and blood vessel invasion. These variables were found to be interdependent. Multivariate analysis selected quality of surgery as the most important variable for predicting local recurrences. The factors selected with regard to overall and metastasis-free survival were tumor size, tumor margins, necrosis, and adequacy of excision. These results permitted classification of patients into four prognostic groups: two with good and two with bad prognosis. Five-year survival for the four groups was 100%, 83%, 53%, and 0%; 5-year metastatic rates were 0%, 12%, 67%, and 100%. Similar groups were obtained when the variables of tumor margins and size were combined with an adaptation of the NCI grading (low-grade tumors/high-grade tumors without necrosis/high-grade tumors with necrosis). Comparative analysis showed that patients with tumors of the same histologic grade or type were not necessarily classed in the same prognostic groups. A better clinicopathologic correlation was obtained using a combination of prognostic factors than with histologic grading or typing alone.

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A combined treatment modality of radiotherapy, surgery, and monochemotherapy in 39 cases of soft tissue sarcomas is presented. The 39 patients presented initially with local disease only, without evidence of metastases. At the end of the surgical procedure the adequacy of the excision had been evaluated by the pathologist. Surgical procedure was complemented by systematic radiation therapy. The overall recurrence rate was 7.7%; the overall incidence of metastases 31%. In the group in which adequate excision had been obtained, no loco-regional recurrences were obtained, survival was significantly better, and the incidence of metastases was lower than in group in whom adequate excision could not be obtained. The importance of two criteria was stress: the depth and the character of the margins of the tumor which cannot be considered separately. The results suggest that there is a correlation between the general and loco-regional malignancy of soft tissue sarcomas.

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