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Tumor size, location, grade predicted late recurrence in soft tissue sarcoma
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Late recurrence in most patients treated for soft tissue sarcoma is uncommon, according to study results.
However, the findings suggest long-term follow-up is necessary to detect late local disease recurrence in patients with retroperitoneal or very large soft tissue sarcomas, as well as late metastatic recurrence among patients with high-grade disease, results showed.
No known prognostic factors exist for late disease recurrence — defined as more than 5 years after initial management — in patients with soft tissue sarcoma, according to background information provided by researchers.
Maud Toulmonde, MD, of the department of medicine at Bergonie Institute in France, and colleagues reviewed follow-up data on 719 patients with localized soft tissue sarcoma included in the French Sarcoma Group database between January 1990 and June 2005. Median follow-up was 9.1 years.
Overall, 9.3% of patients experienced late local recurrence and 5.8% of patients experienced late metastatic recurrence.
“By distinguishing local recurrence from metastatic recurrence in the current analysis, we found that each pattern of recurrence occurs preferentially in distinct subtypes of soft tissue sarcoma and that they are quite different in terms of prognostic factors,” Toulmonde and colleagues wrote.
Multivariate analysis showed the only factors independently associated with increased risk for late local recurrence were internal trunk location (HR=3.9; 95% CI, 2.2-6.7) and a tumor size greater than 100 mm (HR=2.1; 95% CI, 1.1-1.4). The only factor associated with an increased risk for late metastatic recurrence was disease grade >1 (HR= 4.7; 95% CI, 1.1-21).
“In addition to current European Society for Medical Oncology recommendations for the first 5 years, we suggest that patients with retroperitoneal sarcoma and patients with high-grade tumors be followed biannually for up to 10 years,” Toulmonde and colleagues wrote.
The fact that large tumors and internal trunk location were associated with late local disease recurrence, and that patients with higher grade tumors were more likely to develop late metastases, is not surprising, Edwin Choy, MD, PhD, of the division of hematology and oncology at Massachusetts General Hospital, wrote in an accompanying editorial.
“However, it was reassuring to learn that exposure to chemotherapy or radiotherapy, and having R1 surgical margin status, did not appear to individually increase the risk of late disease recurrence,” Choy wrote. “Although the findings reported by Toulmonde et al are quite significant, the real excitement is the hope that this will be one of many more reports that analyze this vast and rich source of clinical data to help us improve the overall health and survival of this cohort of patients who have survived their sarcoma for [longer than] 5 years.”
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Disclosure: The study was supported by the French National Cancer Institute.