An Analysis of Tumor- and Surgery-Related Factors that Contribute to Inadvertent Positive Margins Following Soft Tissue Sarcoma Resection

Kenneth Gundle, Sanjay Gupta, Lisa Kafchinski, Anthony M. Griffin, Rita A. Kandel, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Peter C. Ferguson, Jay S. Wunder

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Abstract

Background: The risk of local recurrence (LR) after soft tissue sarcoma (STS) resection is higher in the setting of inadvertent positive margins (IPMs). This study assessed whether both tumor- and surgery-related factors contribute to IPMs, and whether tumor- versus surgery-related IPMs differ in LR or overall survival (OS). Methods: Retrospective review of a tertiary center database identified patients with IPMs following STS resection between 1989 and 2014. Of 2234 resected STSs, 309 (13%) had positive margins; 89 (4%) were IPMs. Mean follow-up was 52 months, mean tumor size was 9.2 cm, and 55% were high grade. Cases were categorized as surgery-related (67, 75%) or tumor-related (22, 25%). Results: There was a significant difference in positive margin location, with the deep margin commonly involved in surgery-related IPMs (55% vs. 9%; p < 0.001). Tissue type also differed (p = 0.01), with surgery-related IPMs frequently in muscle (33%), while tumor-related IPMs favored subcutaneous tissues (41%). STSs with surgery-related IPMs were larger (p = 0.01). Histologic subtypes differed (p = 0.02), with myxofibrosarcoma and undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma predominating in tumor-related IPMs (82%). The cumulative probability of LR after IPMs, with death as a competing risk, was 28% (95% confidence interval [CI] 18–35) at 5 years and 37% (95% CI 24–45) at 10 years. Mortality was 28% (95% CI 18–38) at 5 years and 38% (26–50) at 10 years. There was no difference in LR (p = 0.91) or OS (p = 0.44) between surgery- and tumor-related IPMS. Conclusions: IPMs after STS resection results in substantial LR risk. While demonstrating distinct surgery- and tumor-related contributions, there was no between-group difference in LR or OS. These results may aid in avoiding IPMs. Level of Evidence: Therapeutic Level III, retrospective comparative study.

Original languageEnglish (US)
Pages (from-to)2137-2144
Number of pages8
JournalAnnals of surgical oncology
Volume24
Issue number8
DOIs
StatePublished - Aug 1 2017

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Sarcoma
Recurrence
Neoplasms
Confidence Intervals
Malignant Fibrous Histiocytoma
Survival
Subcutaneous Tissue
Retrospective Studies
Databases
Muscles
Mortality

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

An Analysis of Tumor- and Surgery-Related Factors that Contribute to Inadvertent Positive Margins Following Soft Tissue Sarcoma Resection. / Gundle, Kenneth; Gupta, Sanjay; Kafchinski, Lisa; Griffin, Anthony M.; Kandel, Rita A.; Dickson, Brendan C.; Chung, Peter W.; Catton, Charles N.; O’Sullivan, Brian; Ferguson, Peter C.; Wunder, Jay S.

In: Annals of surgical oncology, Vol. 24, No. 8, 01.08.2017, p. 2137-2144.

Research output: Contribution to journalArticle

Gundle, K, Gupta, S, Kafchinski, L, Griffin, AM, Kandel, RA, Dickson, BC, Chung, PW, Catton, CN, O’Sullivan, B, Ferguson, PC & Wunder, JS 2017, 'An Analysis of Tumor- and Surgery-Related Factors that Contribute to Inadvertent Positive Margins Following Soft Tissue Sarcoma Resection', Annals of surgical oncology, vol. 24, no. 8, pp. 2137-2144. https://doi.org/10.1245/s10434-017-5848-9
Gundle, Kenneth ; Gupta, Sanjay ; Kafchinski, Lisa ; Griffin, Anthony M. ; Kandel, Rita A. ; Dickson, Brendan C. ; Chung, Peter W. ; Catton, Charles N. ; O’Sullivan, Brian ; Ferguson, Peter C. ; Wunder, Jay S. / An Analysis of Tumor- and Surgery-Related Factors that Contribute to Inadvertent Positive Margins Following Soft Tissue Sarcoma Resection. In: Annals of surgical oncology. 2017 ; Vol. 24, No. 8. pp. 2137-2144.
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abstract = "Background: The risk of local recurrence (LR) after soft tissue sarcoma (STS) resection is higher in the setting of inadvertent positive margins (IPMs). This study assessed whether both tumor- and surgery-related factors contribute to IPMs, and whether tumor- versus surgery-related IPMs differ in LR or overall survival (OS). Methods: Retrospective review of a tertiary center database identified patients with IPMs following STS resection between 1989 and 2014. Of 2234 resected STSs, 309 (13{\%}) had positive margins; 89 (4{\%}) were IPMs. Mean follow-up was 52 months, mean tumor size was 9.2 cm, and 55{\%} were high grade. Cases were categorized as surgery-related (67, 75{\%}) or tumor-related (22, 25{\%}). Results: There was a significant difference in positive margin location, with the deep margin commonly involved in surgery-related IPMs (55{\%} vs. 9{\%}; p < 0.001). Tissue type also differed (p = 0.01), with surgery-related IPMs frequently in muscle (33{\%}), while tumor-related IPMs favored subcutaneous tissues (41{\%}). STSs with surgery-related IPMs were larger (p = 0.01). Histologic subtypes differed (p = 0.02), with myxofibrosarcoma and undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma predominating in tumor-related IPMs (82{\%}). The cumulative probability of LR after IPMs, with death as a competing risk, was 28{\%} (95{\%} confidence interval [CI] 18–35) at 5 years and 37{\%} (95{\%} CI 24–45) at 10 years. Mortality was 28{\%} (95{\%} CI 18–38) at 5 years and 38{\%} (26–50) at 10 years. There was no difference in LR (p = 0.91) or OS (p = 0.44) between surgery- and tumor-related IPMS. Conclusions: IPMs after STS resection results in substantial LR risk. While demonstrating distinct surgery- and tumor-related contributions, there was no between-group difference in LR or OS. These results may aid in avoiding IPMs. Level of Evidence: Therapeutic Level III, retrospective comparative study.",
author = "Kenneth Gundle and Sanjay Gupta and Lisa Kafchinski and Griffin, {Anthony M.} and Kandel, {Rita A.} and Dickson, {Brendan C.} and Chung, {Peter W.} and Catton, {Charles N.} and Brian O’Sullivan and Ferguson, {Peter C.} and Wunder, {Jay S.}",
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AU - Gundle, Kenneth

AU - Gupta, Sanjay

AU - Kafchinski, Lisa

AU - Griffin, Anthony M.

AU - Kandel, Rita A.

AU - Dickson, Brendan C.

AU - Chung, Peter W.

AU - Catton, Charles N.

AU - O’Sullivan, Brian

AU - Ferguson, Peter C.

AU - Wunder, Jay S.

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N2 - Background: The risk of local recurrence (LR) after soft tissue sarcoma (STS) resection is higher in the setting of inadvertent positive margins (IPMs). This study assessed whether both tumor- and surgery-related factors contribute to IPMs, and whether tumor- versus surgery-related IPMs differ in LR or overall survival (OS). Methods: Retrospective review of a tertiary center database identified patients with IPMs following STS resection between 1989 and 2014. Of 2234 resected STSs, 309 (13%) had positive margins; 89 (4%) were IPMs. Mean follow-up was 52 months, mean tumor size was 9.2 cm, and 55% were high grade. Cases were categorized as surgery-related (67, 75%) or tumor-related (22, 25%). Results: There was a significant difference in positive margin location, with the deep margin commonly involved in surgery-related IPMs (55% vs. 9%; p < 0.001). Tissue type also differed (p = 0.01), with surgery-related IPMs frequently in muscle (33%), while tumor-related IPMs favored subcutaneous tissues (41%). STSs with surgery-related IPMs were larger (p = 0.01). Histologic subtypes differed (p = 0.02), with myxofibrosarcoma and undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma predominating in tumor-related IPMs (82%). The cumulative probability of LR after IPMs, with death as a competing risk, was 28% (95% confidence interval [CI] 18–35) at 5 years and 37% (95% CI 24–45) at 10 years. Mortality was 28% (95% CI 18–38) at 5 years and 38% (26–50) at 10 years. There was no difference in LR (p = 0.91) or OS (p = 0.44) between surgery- and tumor-related IPMS. Conclusions: IPMs after STS resection results in substantial LR risk. While demonstrating distinct surgery- and tumor-related contributions, there was no between-group difference in LR or OS. These results may aid in avoiding IPMs. Level of Evidence: Therapeutic Level III, retrospective comparative study.

AB - Background: The risk of local recurrence (LR) after soft tissue sarcoma (STS) resection is higher in the setting of inadvertent positive margins (IPMs). This study assessed whether both tumor- and surgery-related factors contribute to IPMs, and whether tumor- versus surgery-related IPMs differ in LR or overall survival (OS). Methods: Retrospective review of a tertiary center database identified patients with IPMs following STS resection between 1989 and 2014. Of 2234 resected STSs, 309 (13%) had positive margins; 89 (4%) were IPMs. Mean follow-up was 52 months, mean tumor size was 9.2 cm, and 55% were high grade. Cases were categorized as surgery-related (67, 75%) or tumor-related (22, 25%). Results: There was a significant difference in positive margin location, with the deep margin commonly involved in surgery-related IPMs (55% vs. 9%; p < 0.001). Tissue type also differed (p = 0.01), with surgery-related IPMs frequently in muscle (33%), while tumor-related IPMs favored subcutaneous tissues (41%). STSs with surgery-related IPMs were larger (p = 0.01). Histologic subtypes differed (p = 0.02), with myxofibrosarcoma and undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma predominating in tumor-related IPMs (82%). The cumulative probability of LR after IPMs, with death as a competing risk, was 28% (95% confidence interval [CI] 18–35) at 5 years and 37% (95% CI 24–45) at 10 years. Mortality was 28% (95% CI 18–38) at 5 years and 38% (26–50) at 10 years. There was no difference in LR (p = 0.91) or OS (p = 0.44) between surgery- and tumor-related IPMS. Conclusions: IPMs after STS resection results in substantial LR risk. While demonstrating distinct surgery- and tumor-related contributions, there was no between-group difference in LR or OS. These results may aid in avoiding IPMs. Level of Evidence: Therapeutic Level III, retrospective comparative study.

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