The prognostic significance of margin width for extremity and trunk sarcoma

Background and Objectives: To evaluate the significance of resection margin for soft tissue sarcoma (STS), we determined local recurrence-free interval (LRFI), distant metastases-free interval (DMFI), and overall survival (OS) for primary extremity and truncal STS with clear margins (greater than or equal to10 mm), close margins (1-9 mm), and positive margins (0 mm). Methods: Patients were evaluated via review of charts and tumor specimens. Results: Among 111 patients, tumors were predominantly high grade (86%), greater than or equal to5 cm (76%), and deep (81%). A minority of patients received adjuvant radiation (38%) and/or adjuvant chemotherapy (34%). Margin width was greater than or equal to10 mm (48%), 1-9 mm (40%), or 0 mm (12%). Margins greater than or equal to10 mm. were less common for large (P = 0.009) or deep (P = 0.02) tumors. By multivariate analysis, independent factors for LRFI were tumor size (P = 0.04) and margin width (P = 0.03). Independent factors related to DMFI were tumor grade (P = 0.002), size (P = 0.007), and patient age (P = 0.02). Independent factors relating to OS were tumor grade (P = 0.001), size (P = 0.004), and depth (P = 0.03). Conclusions: Margins greater than or equal to 10 mm independently predicted longer LRFI and are optimal for extremity STS resection. Adjuvant radiotherapy should be considered for all STS resected with margins < 10 mm, and margin width should be considered when reporting and interpreting LR outcomes for these patients. (C) 2004 Wiley-Liss, Inc.