TY - JOUR
T1 - Improved Metastatic-Free Survival after Systematic Re-Excision Following Complete Macroscopic Unplanned Excision of Limb or Trunk Soft Tissue Sarcoma
AU - Gouin, Francois
AU - Michot, Audrey
AU - Jafari, Mehrdad
AU - Honoré, Charles
AU - Mattei, Jean Camille
AU - Rochwerger, Alexandre
AU - Ropars, Mickael
AU - Tzanis, Dimitri
AU - Anract, Philippe
AU - Carrere, Sébastien
AU - Gangloff, Dimitri
AU - Ducoulombier, Agnès
AU - Lebbe, Céleste
AU - Guiramand, Jérôme
AU - Waast, Denis
AU - Marchal, Frédéric
AU - Sirveaux, François
AU - Causeret, Sylvain
AU - Gimbergues, Pierre
AU - Fiorenza, Fabrice
AU - Paquette, Brice
AU - Soibinet, Pauline
AU - Guilloit, Jean Marc
AU - Le Nail, Louis R.
AU - Dujardin, Franck
AU - Brinkert, David
AU - Chemin-Airiau, Claire
AU - Morelle, Magali
AU - Meeus, Pierre
AU - Karanian, Marie
AU - Le Loarer, François
AU - Vaz, Gualter
AU - Blay, Jean Yves
N1 - Publisher Copyright:
© 2024 by the authors.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Background: Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. Methods: This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. Results: Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53–0.93; p = 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. Conclusions: RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.
AB - Background: Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. Methods: This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. Results: Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53–0.93; p = 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. Conclusions: RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.
KW - metastatic free survival
KW - multidisciplinary tumor board
KW - reference center
KW - resection margins
KW - soft tissue sarcoma
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85190165797&partnerID=8YFLogxK
U2 - 10.3390/cancers16071365
DO - 10.3390/cancers16071365
M3 - Article
AN - SCOPUS:85190165797
SN - 2072-6694
VL - 16
JO - Cancers
JF - Cancers
IS - 7
M1 - 1365
ER -