Critical study of resection margins in adult soft-tissue sarcoma surgery

SummaryIntroductionResection margins constitute a recognized risk factor for local recurrence, but their impact on survival is less clear.HypothesisInfiltrative proliferation and satellite nodules are prognostic factors for local and systemic aggressiveness.Type of studyRetrospective cohort study.Patients and methodsIn 105 patients under curative treatment, resection quality was assessed on UICC criteria (R0/R1) and on a modified version (R0 M/R1 M) taking account of proliferation contours and satellite nodules for narrow margins (< 1 mm). Uni- and multi-variate analysis was performed, and Kaplan-Meier survival curves were compared on log-rank.ResultsMean 5-year local recurrence-free survival (LRFS) was 0.64 [0.52–0.76] after R1 surgery, 0.9 [0.85–0.95] after R0, 0.64 [0.519–0.751] after R1 M and 0.92 [0.87–0.96] after R0 M. Resection type according to R classification correlated with disease-free survival (DFS) (P = 0.028), but not with metastasis-free survival (MFS) (P = 0.156). Resection type according to RM classification correlated with DFS and MFS. Multivariate analysis disclosed correlations between LRFS rate and RM resection type (HR 6.77 [1.78–25.7], P = 0.005), DFS rate and RM resection type (HR 2.83 [1.47–5.43], P = 0.001) and grade (HR = 3.17 [1.38–7.27], P = 0.003), and MFS and grade (HR = 3.96 [1.50–10.5], P = 0.006).DiscussionThe microscopic aspect of the proliferation contours and presence of satellite nodules were confirmed as prognostic factors for local and systemic aggressiveness. They impact both disease-free survival and metastasis-free survival in case of margins less than 1 mm. Their systematic consideration may help identify patients with elevated systemic risk.Level of evidenceIV.