Prognosis and Treatment of Primary Deep Soft Tissue Sarcomas

The objective of this study was to define the prognostic factors for survival of patients with soft tissue sarcomas (STS) of the extremities located below the muscular fascia. Patients and Methods: One hundred and twenty-seven consecutive patients, resected in our Institution between March 1988 and December 2002, were reviewed. Results: On univariate analysis, the prognostic factors for survival were tumor size, nodal status, adequate surgery, tumor malignancy grade and administered chemotherapy. Additionally, local failure, metastasis after resection and residual tumor after incomplete resection followed by complete resection were adverse prognostic factors for survival. The tumor size, nodal status and metastasis after resection were factors indicating worse survival on multivariate analysis. Conclusion: Our results indicate that most factors influencing the course of the disease cannot be controlled by the surgeon. Complete resection is imperative for local control and allows the patient the chance of a cure. New treatment procedures should be evaluated in prospective trials to optimize therapy. Surgery without sufficient information on the malignancy or expansion of the tumor might be detrimental for the patient. Soft tissue sarcomas (STS) are rare, accounting for 1% of all malignant tumors (1). Even after implementation of radiation, chemotherapy and hyperthermia therapies, surgical tumor resection remains the only curative treatment. For subfascial tumors, whether the optimal surgical procedure performed should be compartmental or wide resection has not definitely been solved in the literature, but it is beyond doubt that clean surgical margins are the crucial factors for the prevention of local recurrrence. Positive resection margins are correlated with a high risk of local recurrence (2-4); some studies have reported a higher risk of metastasis, while other studies have contradicted this thesis (2, 3, 5). Surgery alone, however, cannot guarantee freedom from recurrence and metastasis. The tumor biology has an impact at least as crucial as the tumor size and location (2, 3, 6). Former