The effect of microscopic margin status on survival in adult retroperitoneal soft tissue sarcomas

J. M. Stahl, C. D. Corso, H. S. Park, Y. An, C. E. Rutter, Dale Han, K. B. Roberts

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Introduction Resection is the primary treatment for retroperitoneal (RP) soft tissue sarcomas (STS). Whether obtaining microscopically negative margins (R0) improves overall survival (OS) over microscopically positive margins (R1) remains unclear. Methods Using the National Cancer Data Base, we identified adult patients diagnosed with RP STS after R0 or R1 resection from 1998 to 2011. We used a multivariable logistic regression model to identify clinicopathologic factors associated with margin status, including radiotherapy receipt. To assess differences in OS, the log-rank test, Cox proportional hazards regression, and propensity score matching were used. Results We identified 4015 patients; 2593 (64.6%) underwent R0 resection and 1422 (35.4%) underwent R1 resection. The most common histology was liposarcoma (2,371, 59.1%), median age was 60 years, and median follow up was 67 months. Median OS for R0 vs. R1 patients was 92 and 70 months, respectively (log-rank p < .001). Pre-operative RT was associated with increased probability of R0 resection (68.0% vs. 57.2%, p = .012). Multivariable regression showed R0 vs. R1 resection (HR 0.70, 95% CI 0.60–0.81, p < .001) was associated with improved survival, a finding confirmed on propensity score matching. Other significant predictors of OS included low tumor grade, younger age, smaller tumor size, liposarcoma histology, and receipt of RT (HR 0.81, 95% CI 0.70–0.93, p = .016). Conclusions Patients who undergo R0 resection for RP STS appear to experience superior OS compared with patients who had R1 resections.

Original languageEnglish (US)
Pages (from-to)168-174
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume43
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Sarcoma
Survival
Liposarcoma
Propensity Score
Histology
Logistic Models
Neoplasms
Radiotherapy
Databases

Keywords

  • R0
  • Radiation
  • Resection margin
  • Retroperitoneal soft tissue sarcoma

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

The effect of microscopic margin status on survival in adult retroperitoneal soft tissue sarcomas. / Stahl, J. M.; Corso, C. D.; Park, H. S.; An, Y.; Rutter, C. E.; Han, Dale; Roberts, K. B.

In: European Journal of Surgical Oncology, Vol. 43, No. 1, 01.01.2017, p. 168-174.

Research output: Contribution to journalArticle

Stahl, J. M. ; Corso, C. D. ; Park, H. S. ; An, Y. ; Rutter, C. E. ; Han, Dale ; Roberts, K. B. / The effect of microscopic margin status on survival in adult retroperitoneal soft tissue sarcomas. In: European Journal of Surgical Oncology. 2017 ; Vol. 43, No. 1. pp. 168-174.
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abstract = "Introduction Resection is the primary treatment for retroperitoneal (RP) soft tissue sarcomas (STS). Whether obtaining microscopically negative margins (R0) improves overall survival (OS) over microscopically positive margins (R1) remains unclear. Methods Using the National Cancer Data Base, we identified adult patients diagnosed with RP STS after R0 or R1 resection from 1998 to 2011. We used a multivariable logistic regression model to identify clinicopathologic factors associated with margin status, including radiotherapy receipt. To assess differences in OS, the log-rank test, Cox proportional hazards regression, and propensity score matching were used. Results We identified 4015 patients; 2593 (64.6{\%}) underwent R0 resection and 1422 (35.4{\%}) underwent R1 resection. The most common histology was liposarcoma (2,371, 59.1{\%}), median age was 60 years, and median follow up was 67 months. Median OS for R0 vs. R1 patients was 92 and 70 months, respectively (log-rank p < .001). Pre-operative RT was associated with increased probability of R0 resection (68.0{\%} vs. 57.2{\%}, p = .012). Multivariable regression showed R0 vs. R1 resection (HR 0.70, 95{\%} CI 0.60–0.81, p < .001) was associated with improved survival, a finding confirmed on propensity score matching. Other significant predictors of OS included low tumor grade, younger age, smaller tumor size, liposarcoma histology, and receipt of RT (HR 0.81, 95{\%} CI 0.70–0.93, p = .016). Conclusions Patients who undergo R0 resection for RP STS appear to experience superior OS compared with patients who had R1 resections.",
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