The Prognostic Significance of Margin Width for Extremity and Trunk Sarcoma

Background and Objectives: To evaluate the significance of resection margin for soft tissue sarcoma (STS), we determined local recurrence-free interval (LRFI), distant metastases-free interval (DMFI), and overall survival (OS) for primary extremity and truncal STS with clear margins (≥10 mm), close margins (1-9 mm), and positive margins (0 mm). Methods: Patients were evaluated via review of charts and tumor specimens. Results: Among 111 patients, tumors were predominantly high grade (86%), ≤5 cm (76%), and deep (81%). A minority of patients received adjuvant radiation (38%) and/ or adjuvant chemotherapy (34%). Margin width was ≤10 mm (48%), 1-9 mm (40%), or 0 mm (12%). Margins ≤10 mm were less common for large (P = 0.009) or deep (P = 0.02) tumors. By multivariate analysis, independent factors for LRFI were tumor size (P = 0.04) and margin width (P = 0.03). Independent factors related to DMFI were tumor grade (P=0.002), size (P=0.007), and patient age (P=0.02). Independent factors relating to OS were tumor grade (P = 0.001), size (P = 0.004), and depth (P = 0.03). Conclusions: Margins ≤10 mm independently predicted longer LRFI and are optimal for extremity STS resection. Adjuvant radiotherapy should be considered for all STS resected with margins <10 mm, and margin width should be considered when reporting and interpreting LR outcomes for these patients.