Abstract
Background
Pelvic soft tissue sarcomas are rare. Potentially curative resection remains challenging
due to anatomical constraints of true pelvis and tumour spread through various anatomical
hiatus. We sought to review the oncological outcomes of surgically managed cases at
our centre and determine whether outcomes differ for patients with localised (limited
to pelvis) versus extensive disease (with extra-pelvic extension).
Methods
Sixty-seven patients who underwent surgical resection with curative intent at the
centre for primary, non-metastatic, WHO intermediate to high-grade soft tissue sarcoma
of the true pelvis from January 2012 through January 2020 were analysed. Establishment
of the extent of disease was made by review of pre-treatment imaging and surgical
notes. Oncologic endpoints examined were resection margin, recurrence rate, disease-free
and overall survival.
Results
Rates of complete oncological resection and disease control were similar for tumours
with localised or extensive disease. On logistic regression analysis, tumour grade,
and a negative resection margin (R0) correlated with the risk of recurrence (p=<0.05).
On further multinomial analysis, R0 resection was associated with improved local control,
but not metastatic relapse (p = 0.003).
5-year local recurrence-free and distant metastasis-free survival were 61.3% and 67.1%,
respectively. Five and 10-year overall survival were 64% and 36%, respectively. Age
>50 years and high tumour grade were associated with a worse outcome (p < 0.05).
Conclusions
When potentially curative surgery is performed for pelvic sarcoma, disease-extent
does not influence oncologic outcomes. While a complete oncologic resection determines
the risk of local recurrence, tumour grade and metastatic relapse remain primary prognostic
determinants for overall survival.
Keywords
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Abbreviations
MDTMultidisciplinary Team
WHOWorld Health Organisation
ECOGEastern Cooperative Oncology Group
IBMInternational Business Machines Corporation
LMSLeiomyosarcoma
TAH BSOTotal abdominal hysterectomy and bilateral salpingo-oophorectomy
RTRadiation therapy
DFSDisease free survival
DMFSDistant metastatic relapse free survival
RPSRetroperitoneal sarcoma
GISTGastrointestinal stromal tumour
Article info
Publication history
Published online: December 16, 2022
Accepted:
December 14,
2022
Received in revised form:
December 6,
2022
Received:
October 11,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Crown Copyright © 2023 Published by Elsevier Ltd. All rights reserved.
