Prognostic factors in soft tissue sarcomas. A multivariate analysis of 109 cases

Abstract

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.

Sarcomas in north west England: III Survival

“…histological grade, size, depth, degree of necrosis etc. (Trojani et al, 1984;Rooser et al, 1988;Ueda et al, 1988;Mandard et al, 1989) [ion or on various treatment modalities (Markhede et al, 1982;Bramwell et al, 1985;Suit et al, 1985). In addition, most of tl in sarcoma patients is difficult to assess reliably these observations have been made on hospital-based or on of the rarity of such tumours, their differing toposelected sub-sets of population-based series.…”

Head and neck sarcomas: prognostic factors and implications for treatment

“…Soft tissue sarcomas of the head and neck are uncommon and there is only a small number of reported series (Farr et al, 1981;Littman et al, 1983;Wharam et al, 1984;Greager et al, 1985;Fromm et al, 1986;Harmer et al, 1986;Weber et al, 1986;Tsujimoto et al, 1988;Figueiredo et al, 1988;Freedman et al, 1989;Mandard et al, 1989;Rao et al, 1989;Ruka et al, 1989;Frankenthaler et al, 1990). …”

Prognostic factors for survival in soft tissue sarcoma

“…Costa et al (1984) demonstrated the effect of extent of necrosis on survival and used it in their grading system. Since then other authors (Mandard et al, 1989;Rooser et al, 1988;Trojani et al, 1984) have, like us, shown it to be an independent prognostic factor. Assessment of the extent of necrosis is the most subjective and difficult of the criteria used in grading (Costa et al, 1984;Trojani et al, 1984 (Mandard et al, 1989;Ueda et al, 1988) and site (Collin et al, 1987;Markhede et al, 1982) is well documented in the literature.…”