Fungating soft-tissue sarcomas treatment implications and prognostic importance of malignant ulceration

Benjamin K. Potter, Sheila A Conway, Rabah Qadir, J. David Pitcher, H. Thomas Temple

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Several variables have been reported as being prognostic with regard to the outcomes of soft-tissue sarcomas. Although the tumors are subjectively ominous, no prior study has been performed to evaluate the treatment or prognosis of fungating soft-tissue sarcomas. Methods: We performed a retrospective review of all soft-tissue sarcomas treated at our institution between 1989 and 2004 that had been followed for a minimum of two years or until the death of the patient. Our study group consisted of twenty-four patients with a primary high-grade fungating tumor, and our control group consisted of 146 consecutive patients with a primary high-grade non-fungating tumor. The study cohorts were compared with regard to disease presentation, treatment, and oncologic outcomes. Results: There were no significant differences in tumor size, tumor depth, or histopathologic diagnoses between the cohorts, although the patients with a fungating tumor tended to be older (mean, sixty-five years compared with fifty-five years in the control group; p = 0.004) and have shorter postoperative follow-up (mean, thirty-eight months compared with sixty-five months in the control group; p = 0.03). The proportion of patients presenting with metastases was significantly greater in the group with a fungating tumor (33% compared with 9% in the control group; p = 0.003). Significantly more patients with a fungating tumor underwent amputation (35% compared with 12% in the control group; p = 0.01), while a greater proportion of control patients received radiation therapy (68% compared with 39% in the group with a fungating tumor; p = 0.02). There was no difference in the proportions of patients receiving chemotherapy or in the local recurrence rates between the two cohorts. The Kaplan-Meier five-year overall survival estimates were 20% in the group with a fungating tumor compared with 63% (p < 0.0001) in the control group. The Kaplan-Meier five-year disease-specific survival estimates for patients presenting with localized disease was 58% in the group with a fungating tumor and 74% in the control group (p = 0.05). Multivariate analysis demonstrated that disease stage, fungation, and a tumor size of ≥10 cm were significant independent negative prognostic factors for disease-specific survival. Conclusions: Malignant tumor ulceration is an independent predictor of a poor prognosis for patients with a high-grade soft-tissue sarcoma. Despite the discouraging overall prognosis, aggressive multidisciplinary treatment can lead to long-term survival in an important subgroup of patients with fungating lesions. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)567-574
Number of pages8
JournalJournal of Bone and Joint Surgery - Series A
Volume91
Issue number3
DOIs
StatePublished - Mar 1 2009

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Sarcoma
Neoplasms
Control Groups
Therapeutics
Survival
Amputation
Cohort Studies
Radiotherapy
Multivariate Analysis
Neoplasm Metastasis
Recurrence
Drug Therapy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Fungating soft-tissue sarcomas treatment implications and prognostic importance of malignant ulceration. / Potter, Benjamin K.; Conway, Sheila A; Qadir, Rabah; Pitcher, J. David; Thomas Temple, H.

In: Journal of Bone and Joint Surgery - Series A, Vol. 91, No. 3, 01.03.2009, p. 567-574.

Research output: Contribution to journalArticle

Potter, Benjamin K. ; Conway, Sheila A ; Qadir, Rabah ; Pitcher, J. David ; Thomas Temple, H. / Fungating soft-tissue sarcomas treatment implications and prognostic importance of malignant ulceration. In: Journal of Bone and Joint Surgery - Series A. 2009 ; Vol. 91, No. 3. pp. 567-574.
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AU - Potter, Benjamin K.

AU - Conway, Sheila A

AU - Qadir, Rabah

AU - Pitcher, J. David

AU - Thomas Temple, H.

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N2 - Background: Several variables have been reported as being prognostic with regard to the outcomes of soft-tissue sarcomas. Although the tumors are subjectively ominous, no prior study has been performed to evaluate the treatment or prognosis of fungating soft-tissue sarcomas. Methods: We performed a retrospective review of all soft-tissue sarcomas treated at our institution between 1989 and 2004 that had been followed for a minimum of two years or until the death of the patient. Our study group consisted of twenty-four patients with a primary high-grade fungating tumor, and our control group consisted of 146 consecutive patients with a primary high-grade non-fungating tumor. The study cohorts were compared with regard to disease presentation, treatment, and oncologic outcomes. Results: There were no significant differences in tumor size, tumor depth, or histopathologic diagnoses between the cohorts, although the patients with a fungating tumor tended to be older (mean, sixty-five years compared with fifty-five years in the control group; p = 0.004) and have shorter postoperative follow-up (mean, thirty-eight months compared with sixty-five months in the control group; p = 0.03). The proportion of patients presenting with metastases was significantly greater in the group with a fungating tumor (33% compared with 9% in the control group; p = 0.003). Significantly more patients with a fungating tumor underwent amputation (35% compared with 12% in the control group; p = 0.01), while a greater proportion of control patients received radiation therapy (68% compared with 39% in the group with a fungating tumor; p = 0.02). There was no difference in the proportions of patients receiving chemotherapy or in the local recurrence rates between the two cohorts. The Kaplan-Meier five-year overall survival estimates were 20% in the group with a fungating tumor compared with 63% (p < 0.0001) in the control group. The Kaplan-Meier five-year disease-specific survival estimates for patients presenting with localized disease was 58% in the group with a fungating tumor and 74% in the control group (p = 0.05). Multivariate analysis demonstrated that disease stage, fungation, and a tumor size of ≥10 cm were significant independent negative prognostic factors for disease-specific survival. Conclusions: Malignant tumor ulceration is an independent predictor of a poor prognosis for patients with a high-grade soft-tissue sarcoma. Despite the discouraging overall prognosis, aggressive multidisciplinary treatment can lead to long-term survival in an important subgroup of patients with fungating lesions. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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