Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection

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

Research output: Contribution to journalArticle

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Abstract

Purpose To compare the ability of margin classification systems to determine local recurrence (LR) risk after soft tissue sarcoma (STS) resection. Methods Two thousand two hundred seventeen patients with nonmetastatic extremity and truncal STS treated with surgical resection and multidisciplinary consideration of perioperative radiotherapy were retrospectively reviewed. Margins were coded by residual tumor (R) classification (in which microscopic tumor at inked margin defines R1), the R+1mm classification (in which microscopic tumor within 1 mm of ink defines R1), and the Toronto Margin Context Classification (TMCC; in which positive margins are separated into planned close but positive at critical structures, positive after whoops re-excision, and inadvertent positive margins). Multivariate competing risk regression models were created. Results By R classification, LR rates at 10-year follow-up were 8%, 21%, and 44% in R0, R1, and R2, respectively. R+1mm classification resulted in increased R1 margins (726 v 278, P , .001), but led to decreased LR for R1 margins without changing R0 LR; for R0, the 10-year LR rate was 8% (range, 7%to 10%); for R1, the 10-year LR rate was 12% (10% to 15%) . The TMCC also showed various LR rates among its tiers (P , .001). LR rates for positive margins on critical structures were not different from R0 at 10 years (11% v 8%, P = .18), whereas inadvertent positive margins had high LR (5-year, 28% [95% CI, 19% to 37%]; 10-year, 35% [95% CI, 25% to 46%]; P , .001). Conclusion The R classification identified three distinct risk levels for LR in STS. An R+1mm classification reduced LR differences between R1 and R0, suggesting that a negative but , 1-mm margin may be adequate with multidisciplinary treatment. The TMCC provides additional stratification of positive margins that may aid in surgical planning and patient education.

Original languageEnglish (US)
Pages (from-to)704-709
Number of pages6
JournalJournal of Clinical Oncology
Volume36
Issue number7
DOIs
StatePublished - Mar 1 2018

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Sarcoma
Recurrence
Ink
Residual Neoplasm
Patient Education
Neoplasms
Radiotherapy
Extremities

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. / Gundle, Kenneth; Kafchinski, Lisa; Gupta, Sanjay; Griffin, Anthony M.; Dickson, Brendan C.; Chung, Peter W.; Catton, Charles N.; O'Sullivan, Brian; Wunder, Jay S.; Ferguson, Peter C.

In: Journal of Clinical Oncology, Vol. 36, No. 7, 01.03.2018, p. 704-709.

Research output: Contribution to journalArticle

Gundle, K, Kafchinski, L, Gupta, S, Griffin, AM, Dickson, BC, Chung, PW, Catton, CN, O'Sullivan, B, Wunder, JS & Ferguson, PC 2018, 'Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection', Journal of Clinical Oncology, vol. 36, no. 7, pp. 704-709. https://doi.org/10.1200/JCO.2017.74.6941
Gundle, Kenneth ; Kafchinski, Lisa ; Gupta, Sanjay ; Griffin, Anthony M. ; Dickson, Brendan C. ; Chung, Peter W. ; Catton, Charles N. ; O'Sullivan, Brian ; Wunder, Jay S. ; Ferguson, Peter C. / Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 7. pp. 704-709.
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abstract = "Purpose To compare the ability of margin classification systems to determine local recurrence (LR) risk after soft tissue sarcoma (STS) resection. Methods Two thousand two hundred seventeen patients with nonmetastatic extremity and truncal STS treated with surgical resection and multidisciplinary consideration of perioperative radiotherapy were retrospectively reviewed. Margins were coded by residual tumor (R) classification (in which microscopic tumor at inked margin defines R1), the R+1mm classification (in which microscopic tumor within 1 mm of ink defines R1), and the Toronto Margin Context Classification (TMCC; in which positive margins are separated into planned close but positive at critical structures, positive after whoops re-excision, and inadvertent positive margins). Multivariate competing risk regression models were created. Results By R classification, LR rates at 10-year follow-up were 8{\%}, 21{\%}, and 44{\%} in R0, R1, and R2, respectively. R+1mm classification resulted in increased R1 margins (726 v 278, P , .001), but led to decreased LR for R1 margins without changing R0 LR; for R0, the 10-year LR rate was 8{\%} (range, 7{\%}to 10{\%}); for R1, the 10-year LR rate was 12{\%} (10{\%} to 15{\%}) . The TMCC also showed various LR rates among its tiers (P , .001). LR rates for positive margins on critical structures were not different from R0 at 10 years (11{\%} v 8{\%}, P = .18), whereas inadvertent positive margins had high LR (5-year, 28{\%} [95{\%} CI, 19{\%} to 37{\%}]; 10-year, 35{\%} [95{\%} CI, 25{\%} to 46{\%}]; P , .001). Conclusion The R classification identified three distinct risk levels for LR in STS. An R+1mm classification reduced LR differences between R1 and R0, suggesting that a negative but , 1-mm margin may be adequate with multidisciplinary treatment. The TMCC provides additional stratification of positive margins that may aid in surgical planning and patient education.",
author = "Kenneth Gundle and Lisa Kafchinski and Sanjay Gupta and Griffin, {Anthony M.} and Dickson, {Brendan C.} and Chung, {Peter W.} and Catton, {Charles N.} and Brian O'Sullivan and Wunder, {Jay S.} and Ferguson, {Peter C.}",
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T1 - Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection

AU - Gundle, Kenneth

AU - Kafchinski, Lisa

AU - Gupta, Sanjay

AU - Griffin, Anthony M.

AU - Dickson, Brendan C.

AU - Chung, Peter W.

AU - Catton, Charles N.

AU - O'Sullivan, Brian

AU - Wunder, Jay S.

AU - Ferguson, Peter C.

PY - 2018/3/1

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N2 - Purpose To compare the ability of margin classification systems to determine local recurrence (LR) risk after soft tissue sarcoma (STS) resection. Methods Two thousand two hundred seventeen patients with nonmetastatic extremity and truncal STS treated with surgical resection and multidisciplinary consideration of perioperative radiotherapy were retrospectively reviewed. Margins were coded by residual tumor (R) classification (in which microscopic tumor at inked margin defines R1), the R+1mm classification (in which microscopic tumor within 1 mm of ink defines R1), and the Toronto Margin Context Classification (TMCC; in which positive margins are separated into planned close but positive at critical structures, positive after whoops re-excision, and inadvertent positive margins). Multivariate competing risk regression models were created. Results By R classification, LR rates at 10-year follow-up were 8%, 21%, and 44% in R0, R1, and R2, respectively. R+1mm classification resulted in increased R1 margins (726 v 278, P , .001), but led to decreased LR for R1 margins without changing R0 LR; for R0, the 10-year LR rate was 8% (range, 7%to 10%); for R1, the 10-year LR rate was 12% (10% to 15%) . The TMCC also showed various LR rates among its tiers (P , .001). LR rates for positive margins on critical structures were not different from R0 at 10 years (11% v 8%, P = .18), whereas inadvertent positive margins had high LR (5-year, 28% [95% CI, 19% to 37%]; 10-year, 35% [95% CI, 25% to 46%]; P , .001). Conclusion The R classification identified three distinct risk levels for LR in STS. An R+1mm classification reduced LR differences between R1 and R0, suggesting that a negative but , 1-mm margin may be adequate with multidisciplinary treatment. The TMCC provides additional stratification of positive margins that may aid in surgical planning and patient education.

AB - Purpose To compare the ability of margin classification systems to determine local recurrence (LR) risk after soft tissue sarcoma (STS) resection. Methods Two thousand two hundred seventeen patients with nonmetastatic extremity and truncal STS treated with surgical resection and multidisciplinary consideration of perioperative radiotherapy were retrospectively reviewed. Margins were coded by residual tumor (R) classification (in which microscopic tumor at inked margin defines R1), the R+1mm classification (in which microscopic tumor within 1 mm of ink defines R1), and the Toronto Margin Context Classification (TMCC; in which positive margins are separated into planned close but positive at critical structures, positive after whoops re-excision, and inadvertent positive margins). Multivariate competing risk regression models were created. Results By R classification, LR rates at 10-year follow-up were 8%, 21%, and 44% in R0, R1, and R2, respectively. R+1mm classification resulted in increased R1 margins (726 v 278, P , .001), but led to decreased LR for R1 margins without changing R0 LR; for R0, the 10-year LR rate was 8% (range, 7%to 10%); for R1, the 10-year LR rate was 12% (10% to 15%) . The TMCC also showed various LR rates among its tiers (P , .001). LR rates for positive margins on critical structures were not different from R0 at 10 years (11% v 8%, P = .18), whereas inadvertent positive margins had high LR (5-year, 28% [95% CI, 19% to 37%]; 10-year, 35% [95% CI, 25% to 46%]; P , .001). Conclusion The R classification identified three distinct risk levels for LR in STS. An R+1mm classification reduced LR differences between R1 and R0, suggesting that a negative but , 1-mm margin may be adequate with multidisciplinary treatment. The TMCC provides additional stratification of positive margins that may aid in surgical planning and patient education.

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