TY - JOUR
T1 - The role of surgical margin quality in myxofibrosarcoma and undifferentiated pleomorphic sarcoma
AU - Fujiwara, Tomohiro
AU - Sumathi, Vaiyapuri
AU - Parry, Michael
AU - Stevenson, Jonathan
AU - Tsuda, Yusuke
AU - Kaneuchi, Yoichi
AU - Jeys, Lee
N1 - Funding Information:
This work was supported by a grant-in-aid for overseas research fellowships from the Uehara Memorial Foundation (TF; 201640179) .
Publisher Copyright:
© 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2021/7
Y1 - 2021/7
N2 - Objectives: The effect of margin quality as a barrier against infiltration of soft-tissue sarcomas (STSs) has been unclear. We aimed to investigate the effect of margin quantity and quality on local control for myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS). Methods: 278 patients with a localised MFS and UPS were studied. Margin quality was categorized into five types; type 1, pseudocapsule/reactive zone; type 2, fat/fibrofatty tissue; type 3, muscle; type 4, fascia; type 5, periosteum. Results: The 5-year cumulative LR incidence was 22% and 13% in patients with positive and 0.1–9.9 mm margins, respectively, but decreased to 3% with ≥10.0 mm margins (p = 0.009); the cumulative LR incidence was significantly lower in patients with ≥10.0 mm margins than those with positive margins (p = 0.033) but was not significantly different in those with 0.1–9.9 mm margins (p = 0.183). In patients with 0.1–9.9 mm margins, the cumulative LR incidence was affected by margin quality; type 4 and 5 provided an LR risk less than 5% (p < 0.001), which was similar to those with margins ≥10.0 mm. Combining these two factors together, the LR risk in patients with positive or 0.1–9.9 mm margins without fascia/periosteum was approximately 11 × higher than patients with 0.1–9.9 mm margins with fascia/periosteum or margins ≥10.0 mm (p = 0.002). Conclusions: A resection margin of 0.1–9.9 mm with fascia or periosteum provided a similar LR risk profile to ≥10 mm margins with any margin quality, which provided the lowest LR risk. The quality of fascial or periosteal tissue margins may be equivalent to a margin quantity of 10 mm as a barrier to LR.
AB - Objectives: The effect of margin quality as a barrier against infiltration of soft-tissue sarcomas (STSs) has been unclear. We aimed to investigate the effect of margin quantity and quality on local control for myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS). Methods: 278 patients with a localised MFS and UPS were studied. Margin quality was categorized into five types; type 1, pseudocapsule/reactive zone; type 2, fat/fibrofatty tissue; type 3, muscle; type 4, fascia; type 5, periosteum. Results: The 5-year cumulative LR incidence was 22% and 13% in patients with positive and 0.1–9.9 mm margins, respectively, but decreased to 3% with ≥10.0 mm margins (p = 0.009); the cumulative LR incidence was significantly lower in patients with ≥10.0 mm margins than those with positive margins (p = 0.033) but was not significantly different in those with 0.1–9.9 mm margins (p = 0.183). In patients with 0.1–9.9 mm margins, the cumulative LR incidence was affected by margin quality; type 4 and 5 provided an LR risk less than 5% (p < 0.001), which was similar to those with margins ≥10.0 mm. Combining these two factors together, the LR risk in patients with positive or 0.1–9.9 mm margins without fascia/periosteum was approximately 11 × higher than patients with 0.1–9.9 mm margins with fascia/periosteum or margins ≥10.0 mm (p = 0.002). Conclusions: A resection margin of 0.1–9.9 mm with fascia or periosteum provided a similar LR risk profile to ≥10 mm margins with any margin quality, which provided the lowest LR risk. The quality of fascial or periosteal tissue margins may be equivalent to a margin quantity of 10 mm as a barrier to LR.
KW - Margin
KW - Quality
KW - Quantity
KW - Recurrence
KW - Soft-tissue sarcoma
KW - Surgery
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U2 - 10.1016/j.ejso.2020.11.144
DO - 10.1016/j.ejso.2020.11.144
M3 - Article
C2 - 33342698
AN - SCOPUS:85097902021
VL - 47
SP - 1756
EP - 1762
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
SN - 0748-7983
IS - 7
ER -