BMC Cancer (Oct 2022)

Overall survival in patients with re-excision of positive microscopic margins of limb and trunk wall soft tissue sarcoma operated outside of a reference center: a nationwide cohort analysis

  • Francois Gouin,
  • Eberhard Stoeckle,
  • Charles Honoré,
  • Mickael Ropars,
  • Mehrdad Jafari,
  • Jean Camille Mattei,
  • Alexandre Rochwerger,
  • Sébastien Carrere,
  • Denis Waast,
  • Gwenaël Ferron,
  • Jean-Christophe Machiavello,
  • Philippe Anract,
  • Frédéric Marchal,
  • François Sirveaux,
  • Oren Marco,
  • Jérôme Guiramand,
  • Brice Paquette,
  • Antonio Di Marco,
  • Sylvain Causeret,
  • Jean-Marc Guilloit,
  • Pauline Soibinet,
  • Dimitri Tzanis,
  • Pierre Gimbergues,
  • Fabrice Fiorenza,
  • Franck Dujardin,
  • Louis R. Le Nail,
  • Jean-Christophe Ruzic,
  • Claire Chemin-Airiau,
  • Magali Morelle,
  • Pierre Meeus,
  • Marie Karanian,
  • François Le Loarer,
  • Gualter Vaz,
  • Jean-Yves Blay,
  • on behalf of the NETSARC/RREPS and French Sarcoma Group-Groupe d’Etude des Tumeurs Osseuses (GSF-GETO) networks

DOI
https://doi.org/10.1186/s12885-022-10121-5
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 11

Abstract

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Abstract Background This French nationwide NETSARC exhaustive prospective cohort aims to explore the impact of systematic re-excision (RE) as adjuvant care on overall survival (OS), local recurrence free survival (LRFS), and local and distant control (RFS) in patients with soft tissue sarcoma (STS) with positive microscopic margins (R1) after initial resection performed outside of a reference center. Methods Eligible patients had experienced STS surgery outside a reference center from 2010 to 2017, and had R1 margins after initial surgery. Characteristics and treatment comparisons used chi-square for categorical variables and Kruskall-Wallis test for continuous data. Survival distributions were compared in patients reexcised (RE) or not (No-RE) using a log-rank test. A Cox proportional hazard model was used for subgroup analysis. Results A total of 1,284 patients had experienced initial STS surgery outside NETSARC with R1 margins, including 1,029 patients with second operation documented. Among the latter, 698 patients experienced re-excision, and 331 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, tumor size, tumor depth, and histotype in the population of patients re-excised (RE) or not (No-RE). The study identified RE as an independent favorable factor for OS (HR 0.36, 95%CI 0.23–0.56, p<0.0001), for LRFS (HR 0.45, 95%CI 0.36–0.56, p<0.0001), and for RFS (HR 0.35, 95%CI 0.26–0.46, p<0.0001). Conclusion This large nationwide series shows that RE improved overall survival in patients with STS of extremities and trunk wall, with prior R1 resection performed outside of a reference center. RE as part of adjuvant care should be systematically considered. Level of evidence II

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