Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Smolle, M.
Unplanned excisions of soft tissue sarcoma: Influence on therapy and patients’ survival
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2016. pp.
[OPEN ACCESS]
FullText
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leithner Andreas
- Szkandera Joanna
- Altmetrics:
- Abstract:
- Introduction: Unplanned excisions (UE) of soft tissue sarcomas (STS) are a widely known therapeutic dilemma. The atypical presentation and absence of „worrying“ features may tempt inexperienced surgeons to perform surgery. The aim of this diploma thesis was to determine the influence of unplanned excisions on further therapy and patient’s prognosis. Patients and Methods: 427 patients referred since 1998 to our institution were included. Statistical analysis was carried out using SPSS Version 22.0. Tumour-, patient- and treatment-related parameters were compared between directly referred and inappropriately excised patients. Survival analysis was carried out excluding patients with primary metastasis and amputations, resulting in 376 patients eligible. A two-sided p-value < 0.05 was accepted as statistically significant. Results: 212 patients were female and 215 male. 165 patients had undergone an UE (38.6%) prior to referral. 392 patients underwent limb-sparing surgery at our department, whereas in 35 patients, an amputation was necessary. UE-patients had significantly more often small (p<0.005) as well as superficial (p<0.005) tumours and required more often plastic reconstructions (p<0.005) than directly referred ones. Neither univariate (p=0.120) nor multivariate (p=0.147) Cox-regression-analysis revealed an altered overall-survival for UE patients, though a trend towards a slightly better prognosis was visible. In both groups, multivariate analysis identified high-grade tumours as a significant negative prognostic factor (p<0.005; HR: 3.827, 95%CI: 1.965-7.453 in directly referred patients and p=0.007; HR: 4.791, 95%CI: 1.526-15.036 in UE patients). However, in the directly referred group only age over 60 was an additional significant parameter (p=0.009; HR:2.223, 95%CI: 1.217-4.063), whereas in the UE group duration of symptoms less than 6 months (p=0.020; HR: 0.347, 95%CI: 0.142-0.849) and local recurrence (p=0.002; HR: 4.867, 95%CI: 1.764-13.422) were additional negative prognostic factors. Conclusion: Although the prognosis of STS-patients is not impaired after an UE, they require more often extensive surgery with plastic reconstruction, possibly impairing their quality of life. Additionally, local recurrence is a particularly poor prognostic factor when occurring after UE. For these reasons, UE of soft tissue sarcomas should be avoided.