The role of surgical margin quality in myxofibrosarcoma and undifferentiated pleomorphic sarcoma. Issue 7 (July 2021)

• Record Type: Journal Article
• Authors: Fujiwara, Tomohiro; Sumathi, Vaiyapuri; Parry, Michael; Stevenson, Jonathan; Tsuda, Yusuke; Kaneuchi, Yoichi; Jeys, Lee
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 7(2021)
• Page Start: 1756
• Page End: 1762
• Publication Date: 2021-07
• Subjects: Soft-tissue sarcoma -- Surgery -- Margin -- Quality -- Quantity -- Recurrence; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.11.144
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: 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.