The objectives of this study were to clarify whether localized extremity soft tissue sarcoma (STS) patients who underwent amputation surgery experienced worsened survival and to identify those patients for whom amputation surgery worsened survival.
Using the Surveillance, Epidemiology, and End Results database, we identified 8897 patients with localized extremity STS between 1983 and 2016. Of these 6431 patients, 733 patients underwent amputation surgery (Amputation group), and 5698 underwent limb-sparing surgery (Limb-sparing group).
After adjusting for patient background by propensity score matching, a total of 1346 patients were included. Patients in the Amputation group showed worsened survival (cancer-specific survival (CSS): hazard ratio (HR) = 1.42, 95% confidence interval (CI) 1.15–1.75, overall survival (OS): HR = 1.41, 95%CI 1.20–1.65). In subclass analysis, patients with high-grade STS, spindle cell sarcoma and liposarcoma in the Amputation group showed shortened survival (high-grade–CSS: HR = 1.44, 95%CI 1.16–1.77, OS: HR = 1.38, 95%CI 1.18–1.62; spindle cell sarcoma–CSS: HR = 4.75, 95%CI 1.56–14.4, OS: HR = 2.32, 95%CI 1.45–3.70; liposarcoma–CSS: HR = 2.91, 95%CI 1.54–5.50, OS: HR = 2.32, 95%CI 1.45–3.70).
Survival was shortened in localized extremity STS patients who received amputation surgery.
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- The National Cancer Data Base report on soft tissue sarcoma.Cancer. 1996 Nov 15; 78: 2247-2257
- Impact of smoking history on pulmonary metastasis-free survival in patients with soft-tissue sarcoma.Cancer Diagnosis Prognosis. 2021; 1: 89-94
- Cancer statistics.CA Cancer J Clin. 2020; 70 (2020 Jan): 7-30
- Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas.Ann Surg. 2002 Mar; 235: 424-434
- Soft tissue sarcomas of the extremities: surgical margins can Be close as long as the resected tumor has No ink on it.Oncologist. 2017 Nov; 22: 1400-1410
- UK guidelines for the management of soft tissue sarcomas.Clin Sarcoma Res. 2016; 6: 20
- Classification of positive margins after resection of soft-tissue sarcoma of the limb predicts the risk of local recurrence.J Bone Joint Surg Br. 2001 Nov; 83: 1149-1155
- Soft tissue sarcoma of the upper extremity: a 5-year experience at two institutions emphasizing the role of soft tissue flap reconstruction.Cancer. 2000 Apr 15; 94: 2256-2264
- Microvascular reconstruction after resection of soft tissue sarcoma of the leg.Br J Surg. 2009 May; 96: 482-489
- Amputation for soft-tissue sarcoma.Lancet Oncol. 2003 Jun; 4: 335-342
- Major amputations for extremity soft-tissue sarcoma.Ann Surg Oncol. 2018 Feb; 25: 387-393
- The indications for and the prognostic significance of amputation as the primary surgical procedure for localized soft tissue sarcoma of the extremity.Ann Surg Oncol. 2005 Jan; 12: 10-17
- Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities.J Clin Oncol. 1996 May; 14: 1679-1689
- Primary soft tissue sarcoma of the extremities in adults.Br J Surg. 1995 Sep; 82: 1208-1212
- Amputation for recurrent soft tissue sarcoma of the extremity: indications and outcome.Ann Surg Oncol. 2001 Jul; 8: 509-518
- Staging of hepatocellular carcinoma: assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan.Ann Surg. 2007 Jun; 245: 909-922
- Critical evaluation of the American Joint commission on cancer (AJCC) 8th edition staging system for patients with hepatocellular carcinoma (HCC): a surveillance, Epidemiology, End results (SEER) analysis.J Surg Oncol. 2018 Mar; 117: 644-650
- The new TNM-based staging of breast cancer.Virchows Arch. 2018 May; 472: 697-703
- Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system.Int J Cancer. 1984 Jan 15; 33: 37-42
- Surgical resection of primary tumor in the extremities improves survival for metastatic soft-tissue sarcoma patients: a population-based study of the SEER database.Clin Transl Oncol. 2021 Dec; 23: 2474-2481
- The AJCC 8th edition staging system for soft tissue sarcoma of the extremities or trunk: a cohort study of the SEER database.J Natl Compr Canc Netw. 2018 Feb; 16: 144-152
- Evaluating factors associated with unknown SEER Summary Stage 2000 derived from collaborative stage at central registry level.J Registry Manag. 2012 Fall; 39: 101-106
- Evaluation and prediction analysis of 3- and 5-year survival rates of patients with cecal adenocarcinoma based on period analysis.Int J Gen Med. 2021; 14: 7317-7327
- Amputation for extremity soft tissue sarcoma does not increase overall survival: a retrospective cohort study.Eur J Surg Oncol. 2012 Dec; 38: 1178-1183
- Disparities in amputation rates for non-metastatic extremity soft tissue sarcomas and the impact on survival.Ann Surg Oncol. 2021 Jan; 28: 576-584
- Outcome and prognostic factors in soft tissue sarcoma in the adult.Int J Radiat Oncol Biol Phys. 1993 Dec 1; 27: 1091-1099
- Vascular invasion in high grade sarcoma of the extremity is associated with short overall survival.Oncol Rep. 1998 Jul-Aug; 5: 985-989
- Bone invasion in extremity soft-tissue sarcoma: impact on disease outcomes.Cancer. 2006 Jun 15; 106: 2692-2700
- Musculoskeletal metastasis from soft-tissue sarcomas: a review of the literature.J Am Acad Orthop Surg. 2022 Jun 1; 30: 493-503
Published online: March 15, 2023
Accepted: February 26, 2023
Received in revised form: February 21, 2023
Received: November 1, 2022
Publication stageIn Press Corrected Proof
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