Fatores prognósticos para o desenvolvimento de metástases e recidiva localnos sarcomas de tecidos moles em extremidades

Abstract

INTRODUCTION: The term soft tissue sarcoma (STS) defines a heterogeneous group of extra-skeletal malignant neoplasms originated from the extra-skeletal mesenchymal tissues, representing 1% of all types of cancer. Surgery is the principal method of treatment and the indication of adjuvant treatment remains controversial and depends of the prognostic factors associated with the occurrence of metastases and local relapse of the disease. OBJECTIVE: Determinate the correlaction between the most frequent studied prognostic factors with the local relapse and developing of distant metastasis in patients with soft tissue sarcoma in extremities. PATIENTS AND METHOD: we retrospectively evaluated 30 patients treated with surgical resection of a STSlocated in extremities, with a minimal outcome of 12 months. The prognostic factors evaluated were: age (< 50 years or = 50 years), sex, location of the tumors in the body (superior limb, inferior limb, pelvic girdle), depth (superficial or deep), location in the anatomic compartments (intra or extracompartimental), size (= 10 cm or >10 cm), tumor previous manipulation, surgical margins (free or contaminated), grade of histological malignance (low or high), presence of histological necrosis or histological vascular invasion. These factors were correlated with the posterior diagnosis of metastases and local relapse of the tumor, with a bivariated and multivariated analysis considering significant when p = 0,05. RESULTS: In the bivariated analyses the development of metastases were correlated with extra-compartimental location (p = 0,002), with size > 10 cm (p = 0,007), with high grade of malignance (p = 0,007), with the presence of necrosis (p = 0,002) and vascularinvasion (p = 0,034). Age (p = 1,000), sex (0,709), body location (p = 0,298), depth (p = 0,288), surgical margins (p = 0,419) and previous manipulation (p = 1,000) dont correlate with distant metastases. In multivariated analyses only extra-compartimental location (p = 0,008), size > 10 cm (p = 0,018) and vascular invasion (p = 0,043) were significant. Local relapse presented significant correlaction in bivariated and multivariated analyses with extracompartimental location (p = 0,001) and with high grade histological malignance (p = 0,001). There was no significant association with age (p = 1,000), sex (p = 1,000), body location (p = 0,544), depth (p = 0,288), size (p = 0,694), surgical margins (p = 0,384), previous manipulation (p = 0,461), necrosis (p = 0,461) or with the presence of vascular invasion (p = 1,000). CONCLUSION: The development of distant metastases in patients with soft tissue sarcomadepends of the extra-compartimental location, the size (> 10 cm), the highgrade of histological malignance and the presence of necrosis and vascular invasion on histology. Local relapse presents correlaction with extracompartimental location and with high grade malignance tumors.