Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kainhofer, V.
Local recurrence after resection of soft tissue sarcomas: a multifactorial analysis.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2015. pp.
[OPEN ACCESS]
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leithner Andreas
- Szkandera Joanna
- Altmetrics:
- Abstract:
- Background. Patients with soft tissue sarcoma (STS) being treated following the standardized guidelines, i.e. resection and adjuvant radiation therapy for selected patients, can still not be guaranteed to remain free from local recurrence (LR) of the sarcoma at resection site. This study was designed to analyse various characteristics of patients and tumors and their potential impact on local recurrence. Methods. This retrospective study included 374 patients, who were diagnosed with STS and underwent resection between 1998 and 2013. Analyses included histological reports, surgery reports and follow up for recurrence and survival of each patient with focus on the factors resection margin, grading, size, depth of the tumor and age and gender of the patient. Two different classifications were applied for the factor resection margin. Applied statistical methods were the Kaplan-Meier survival curve analysis, Log rank test, Cox proportional hazards model and cross tabulations with chi-square test. For statistical analyses SPSS 22 was used. Results. In univariate cox regression analysis the significant factors for local recurrence resulted to be age (HR 4,19 for =50 years, 95%CI=1,28–13,74, p=0,018) and resection margin for two different classifications (R-classification: HR 5,62 for R1, 95%CI=2,67–11,84, p<0,01; UICC-classification: HR 10,08 for R1, 95%CI=2,87–35,41, p<0,01). In multivariate cox regression analyses the significant factors for LR were gender (HR 2,24 for male, 95%CI=1,04–4,84, p=0,04), age (HR 3,77 for =50 years, 95%CI=1,15–12,44, p=0,029), grading (HR 2,70 for G2+G3, 95%CI=1,00–7,27, p=0,049) and R-classification (HR 7,94 for R1, 95%CI=3,52–17,94, p<0,01). When the UICC-classification was applied for resection margin status it resulted as the only significant factor in multivariate cox regression analysis (HR 9,44 for R1, 95%CI=2,57–34,68, p<0,01). In chi-square analysis there was a trend for higher local recurrence rates in the lower extremity compared to the upper extremity and STS of the trunk. Kaplan-Meier survival curve analysis showed a lower LR rate for R0 resection in the following the UICC-classification compared to the R-classification. Five-year LR rates were at 6 percent (UICC) versus 10 percent (R) respectively. Conclusions. Negative resection margin (R0) is a crucial factor for low local recurrence rates. In our study, a favourable outcome for a minimal resection margin of one millimeter was observed as the local recurrence statistics resulted significantly lower when this definition was applied for the resection margin status. Further factors that were identified to be significant for local recurrence mainly go in accordance with the literature and were age, grading and gender.