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J Surg Oncol. 2019 Jan 4. doi: 10.1002/jso.25359. [Epub ahead of print]

Distal extremities soft tissue sarcomas: Are they so different from other limb localizations?

Author information

1
Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Départment de Chirurgie Orthopédique des Prs. Curvale et Rochwerger, Marseille, France.
2
Faculté de Médecine de la Timone, Génétique Médicale et génomique fonctionnelle, UMR S910 Inserm, Université Aix-Marseille 2, Marseille, France.
3
Institut Bergonie, INSERM U 897, Département Biostatistique, ISPED, Université Victor Segalen Bordeaux 2, Case 11, Bordeaux, France.
4
Département de Biologie et de Pathologie Médicales, Institut de Cancérologie Gustave-Roussy, Villejuif, France.
5
Institut Curie, Département de Chirurgie 8, PSL Research University, Paris, France.
6
Department of Medical Oncology, Gustave Roussy, Villejuif, France.
7
Department of Surgery, Institut Bergonié, Regional Cancer Centre, Bordeaux, France.
8
Departement d'oncologie Medicale, CLCC Institut Bergonie, Bordeaux, France.
9
Department of Pathology, Leon Berard Center, Lyon, France.
10
Department of Surgery, Centre Leon Berard, University Lyon 1, Lyon, France.
11
Service de Pathologie, Institut Curie, Paris Sciences Lettres Research University, Département de Médecine Diagnostique et Théranostique, Paris, France.
12
Service de Pathologie, Centre Henri Becquerel, INSERM U1245, UNIROUEN, Normandie Université, rue d'Amiens, Rouen, France.
13
Département Chirurgie Orthopédique et Traumatologique 2, Hôpital Trousseau, Université François-Rabelais de Tours, CHU de Tours, Tours, France.
14
Département d'anatomo-pathologie de l'Institut Bergonié.
15
Department of Oncology, Assistance Publique Hôpitaux de Marseille Timone Hospital, Marseille, France.

Abstract

BACKGROUND AND OBJECTIVES:

Soft tissue sarcoma localization in distal extremities (DESTS) of the limbs (hand/fingers, and foot/toes) is unusual. The literature is scarce about their behavior and this study was designed to assess their epidemiological characteristics, outcomes, and prognosis compared to other limb localizations (OLSTS).

METHODS:

From 1980 to 2010, adult DESTS and OLSTS in 22 centers were included. Demographics, tumor type, treatment modalities, and latest follow-up status were collected. Primary endpoints were overall survival and local/metastatic recurrence incidences.

RESULTS:

Two hundred five DESTS and 3001 OLSTS were included. The patients were younger, with more female and smaller tumors in DESTS. There were more clear cell/epithelioid sarcomas, synovial sarcomas, and myxoid liposarcomas vs more dedifferentiated liposarcomas in OLSTS. DESTS tumors were less irradiated and more often amputated (24.3% vs 3.4%). The five-year survival rate was 78.2% compared to 68.6% in OLSTS and after multivariate analysis, STS localization did not impact survival or local/metastatic recurrence.

CONCLUSION:

Though rare and smaller than other limb localizations, DESTS are to be considered as aggressive. Despite a higher amputation rate, the prognosis remains the same as in OLSTS. Limb sparing vs amputation should be carefully assessed in DESTS, especially if grade 3 or of a poor prognosis histological subtype.

KEYWORDS:

distal extremity; limb; outcomes; prognosis factors; soft tissue sarcoma

PMID:
30609044
DOI:
10.1002/jso.25359

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