Page 42 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 2
Table 2. Surgical margins in relation to tumor grade. There was no signi cant association between tumor grade and resection margins (chi squared test, p=0.110).
Wide
9 (30) 51 (55) 23 (59)
Marginal
12 (40) 23 (25) 7 (18)
Intralesional
Total
Grade 1 Grade 2 Grade 3
Results
9 (30) 30 19 (20) 93 9 (23) 39
Oncological outcome and risk factors for impaired outcome
At the time of latest follow-up, 96 patients (59%) were alive: 71 (44%) continuously had no evidence of disease, 19 (12%) had no evidence of disease following treatment of local relapse or metastasis and six (4%) were alive with disease. Sixty- six patients (41%) died during follow-up: 55 patients (34%) died from disease and 11 patients (7%) died from other causes.
The median disease-speci c survival could not be determined because the survival curve did not cross 0.5; estimated mean disease-speci c survival was 17.6 years (95% CI, 15.5 to 19.6 years) ( gure 4). The estimated median progression- free survival was 9.3 years (95% CI, 3.3 to 15.3 years). Sixty-two patients (38%) experienced local recurrence: nine grade 1 lesions (30%), 31 grade 2 lesions (33%) and 22 grade 3 lesions (56%) (p=0.027) (table 3). Four recurrent tumors (6% of 62) were of higher grade than the original tumor. Recurrent lesions were diagnosed after a median of 1.7 years (range, 0.1 to 27.3); 36 (58%) within two and 59 (95%) within ve years.
The risk of disease-related death was 3% (1 of 30) for grade 1, 33% (31 of 93) for grade 2, and 54% (21 of 39) for grade 3 tumors. The patient with a grade 1 lesion who died of disease had a grade 2 recurrence that metastasized. Overall, metastases were diagnosed in 48 patients (30%), after a median of 1.9 years (range, 0.1 to 10.6). Of these, 42 (88%) died of disease, four (8%) were alive with disease at the time of latest follow-up, and two (4%) had no evidence of disease following pulmonary metastasectomy. The risk of metastasis was 32% (30 of 93) for grade 2 and 44% (17 of 39) for grade 3 tumors.
Patients with a local recurrence had a higher risk of metastases (32 of 62 [52%] versus 18 of 100 [18%]; OR 4.3, 95% CI 2.1 to 8.7, p < 0.001) and disease-related death (39 of 62 [63%] versus 16 of 100 [16%]; OR 8.9, 95% CI 4.2 to 18.7, p < 0.001).
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