Patient characteristics
The present retrospective study comprised 18 patients (8 men and 10 women) with sarcoma who underwent surgery in our department (Table 1). Among patients with bone tumors, the tumor site was the femur in three patients, tibia in three, fibula in one, and humerus in one. In terms of histology, six had osteosarcoma and two had chondrosarcoma. Six patients had histological high-grade tumors and two had low-grade tumors. One, three, two, and one patient had stage IB, IIA, IIB, and IVB disease, respectively. Five patients had an ECOG-PS score of 0, two had an ECOG-PS score of 1, and one had an ECOG-PS score of 2. Seven patients had an ASA-PS score of 1, and one had an ASA-PS score of 2.
Among patients with soft tissue tumors, the tumor site was the thigh in five patients, buttock in two, upper extremity in one, abdomen in one, and groin in one.
In terms of histology, five had liposarcoma, three had synovial sarcoma, one had Ewing sarcoma, and one had leiomyosarcoma. Nine patients had histological high-grade tumors, and one had a low-grade tumor. One, two, three, two, and two patients had stage I, II, IIIA, IIIB, and IVB disease, respectively. Seven patients had an ECOG-PS score of 0, and three patients had an ECOG-PS score of 1. Eight patients had an ASA-PS score of 1, one had an ASA-PS score of 2, and one had an APA-PS score of 3.
Treatment
Five patients with bone tumors received wide resection with neoadjuvant chemotherapy (NECO-95J) [13], and three received curettage resection. Of the patients who received wide resection, four achieved R0 resection and one achieved R1 resection. Six patients with soft tissue tumors received wide resection with neoadjuvant chemotherapy (five patients: 5 g/m2 ifosfamide and 75 mg/m2 doxorubicin [14], and one patient: 1.5 mg/m2 vincristine, 37.5 mg/m2 doxorubicin, 1,200 mg/m2 cyclophosphamide, 1.8 g/m2 ifosfamide, and 100 mg/m2 etoposide for Ewing sarcoma [15]). Four patients received wide resection without any preoperative therapy, although one received postoperative radiation therapy (60 Gy: 2 Gy/day, 5 days/week). Eight of the patients with soft tissue tumors achieved R0 resection and two achieved R1 resection.
The mean operation time for all patients was 175.5 minutes (range, 95–500 minutes). The mean operation time for patients with bone tumors was 142.5 minutes (range, 95–364 minutes), and the mean operation time for patients with soft tissue tumors was 227.5 minutes (range, 108–500 minutes). The mean intraoperative blood loss in all patients was 266 mL (range, 10–935 mL). The mean intraoperative blood loss in patients with bone tumors was 446 mL (range, 10–860 mL), and the mean intraoperative blood loss in patients with soft tissue tumors was 215.5 mL (range: 10–935 mL). There were no postoperative complications in all current cases.
Outcomes
We followed up patients for 8-162 (mean: 44) months. Two patients with bone tumors and two with soft tissue tumors developed local recurrence. Two patients with bone tumors and three with soft tissue tumors developed distant metastasis. Among patients with bone tumors, five were continuously disease-free (CDF), one had no evidence of disease (NED), and two were DOD. Among patients with soft tissue tumors, five were CDF, two had NED, and three were DOD. The 3-year survival rate of all of the patients was 61.3% (Figure 1A). The 3-year survival rate of younger patients (<33 years) was 56% and that of older patients (>33 years) was 60%. There was no significant difference in the 3-year survival rate based on age (P = 0.46, Figure 1B). The 3-year survival rate among patients with high-grade sarcoma was 42.8% and that among patients with low-grade sarcoma was 100%. There was no significant difference in the 3-year survival rate based on sarcoma grade (P = 0.08, Figure 1C).
We also surveyed the features of the DOD cases. Three of five (60%) patients in the DOD group had ≥ stage IV disease. All patients who had R1 margins developed recurrence. Moreover, all patients with an ASA-PS ≥ 2 died.