Soft tissue sarcoma – a population-based, nationwide study with special emphasis on local control

Figures & data

Table I. Initial diagnoses (n = 219) and histological review of the 200 cases available.

Initial diagnosis	n (%)	Reviewed diagnosis	n† (%)
MFH	91 (41.6)	MFH	93 (47.4)
Liposarcoma	44 (20.0)	Liposarcoma	32 (16.3)
Leiomyosarcoma	36 (16.4)	Leiomyosarcoma	26 (13.3)
Synovial Sarcoma	22 (10.0)	Synovial Sarcoma	21 (10.7)
Fibrosarcoma	8 (3.7)	Fibrosarcoma	6 (3.1)
Sarcoma otherwise specified	10 (4.6)	Sarcoma otherwise specified	13 (6.6)
Sarcoma not otherwise specified	8 (3.7)	Sarcoma not otherwise specified	5 (2.6)
Grade*
1	4 (1.9)	1	0
2	46 (22.0)	2	39 (19.9)
3	60 (28.7)	3	54 (27.6)
4	72 (34.4.)	4	99 (50.5)
Low	6 (2.9)	Low	2 (1.0)
High	21 (10.0)	High	2 (1.0)
Tumour size reported
Yes	178 (81.3)
No	41 (18.7)
Smallest margin (in cm) reported
Yes	179 (81.8)
No	40 (18.2)

MFH, malignant fibrous histiocytoma. *Not reported in 10 original pathology reports. †One patient with reviewed diagnosis of myxoma, one with ossifying fibrous tumour and two patients with grade I liposarcoma excluded.

Table II. Characteristics of patients and tumors treated at HVCs, IVCs, and LVCs.

Variable	HVC n (%)	IVC n (%)	LVC n (%)	p-value^‡
Sex
Male	91 (59.5)	24 (60.0)	17 (77.3)	0.271
Female	62 (40.5)	16 (40.0)	5 (22.7)
Age at diagnosis
Mean (SD), range	59.8 (16.6), 18–92	62.5 (18.3), 24–87	72.7 (15.8), 37–95	0.003
Size
Mean (SD), range	7.5 (5.5), 0.7–35.0	8.7 (6.5), 1.8–24.0	7.1 (4.8), 1.3–18.0	0.686
Grade*
High	120 (78.4)	28 (70.0)	14 (66.7)	0.323
Low	33 (21.6)	12 (30.0)	7 (33.3)
Location
Intracompartmental	26 (17.0)	4 (10.0)	0	0.072
Extracompartmental	127 (83.0)	36 (90.0)	22 (100.0)
Depth
Superficial^†	43 (28.1)	11 (15.7)	12 (54.5)	0.038
Deep	110 (71.9)	29 (84.3)	10 (45.5)
Site
Trunk	43 (28.1)	9 (22.5)	10 (45.5)	0.194
Lower Extremity	77 (50.3)	25 (62.5)	7 (31.8)
Upper Extremity	33 (21.6)	6 (15.0)	5 (22.7)

HVC, high-volume centre; IVC, intermediate-volume centre; LVC, low-volume centre; SD, standard deviation. *One tumour ungraded at LVC and not available for review. ^†Subcutaneous tumours with or without cutaneous extension but without involvement of the investing fascia. ^‡By χ² test or Fisher's exact test.

Table III. Preoperative investigations.

	HVC n (%)	IVC n (%)	LVC n (%)	p-value
Referred to a HVC after
Fine needle aspiration	7 (4.6)
Core needle biopsy	10 (6.5)
Incisional biopsy	3 (2.0)
Intralesional surgery	40 (26.1)
Marginal surgery	18 (11.8)
Untouched	75 (49.0)
Preoperative diagnosis*
Cytology	2 (2.1)	4 (4.1)	2 (9.1)	<0.0001
Core needle biopsy	81 (84.4)	15 (15.5)	3 (13.6)
Open biopsy	9 (9.4)	3 (3.1)	0
None	4 (4.2)	75 (77.3)	17 (77.3)
Radiological diagnosis*,^†
Yes	93 (96.8)	33 (34.0)	7 (31.8)	<0.0001
No	3 (3.2)	64 (66.0)	15 (68.2)
Lung CT for high-grade tumours^‡
Yes	58 (74.4)	9 (56.3)	2 (50.0)	0.198
No	20 (25.6)	7 (43.7)	2 (50.0)

*119 patients had first surgery at IVC or LVC. ^†MRI or CT of the primary tumour. ^‡98 patients with biopsy-proven high-grade tumour. ^¶χ² test or Fisher's exact test. CT, computed tomography; HVC, high-volume centre; IVC, intermediate-volume centre; LVC, low-volume centre; MRI, magnetic resonance imaging.

Table IV. Treatment characteristics.

	HVC n (%)	IVC n (%)	LVC n (%)	P-value
Number of operations*
1	90 (93.8)	20 (48.8)	15 (19.2)	<0.0001
2	6 (6.2)	21 (51.2)	57 (73.1)
3	0	0	6 (7.7)
First surgery performed at^†
Primary health care center	0	0	14 (22.2)
District hospital	0	16 (76.2)	41 (65.1)
Private hospital	0	0	8 (12.7)
University hospital	6 (100)	5 (23.8)	0
First Margin^†
Intralesional	3 (50)	16 (76.2)	48 (76.2)
Marginal	3 (50)	5 (23.8)	15 (23.8)
Definite surgery performed at Primary health care center		0	4 (18.2)
District hospital		15 (37.5)	17 (77.3)
Private hospital		0	1 (4.5)
University hospital	153 (100)	25 (62.5)	0
Definite margin^‡
Intralesional	26 (17.0)	9 (22.5)	9 (42.9)	0.004
Marginal	79 (51.6)	24 (60.0)	9 (42.9)
Wide	48 (31.4)	7 (17.5)	3 (14.2)
Surgery Extent^¶
Amputation	10 (9.1)	3 (9.7)	3 (25.0)	0.281
Limb-sparing surgery	100 (90.9)	28 (90.3)	9 (75.0)
Radiation therapy^§
Yes	79 (75.2)	18 (56.3)	6 (31.6)	<0.0001
No	26 (24.8)	14 (43.7)	13 (68.4)
Chemotherapy
Yes	25 (16.3)	0	1 (4.5)	0.003
No	128 (83.7)	40 (100.0)	21 (95.5)

HVC, high-volume centre; IVC, intermediate-volume centre; LVC, low-volume centre. *based on the hospital of first surgery. ^†For 90 patients having more than one surgery. ^‡Not known for one patient with an amputation. ^¶153 tumours of the extremities. ^§for patients with intralesional or marginal definite surgery. ^#χ²test or Fisher's exact test.

Figure 1. Local control at high-volume centres (—), at intermediate-volume centres (-·-·-·), and at low-volume centres (----). Local control at five years 82%, 61% and 69% (p = 0.046).