Designing a Rational Follow-Up Schedule for Patients with Extremity Soft Tissue Sarcoma

Purpose The risk of tumor recurrence after resection of soft tissue sarcoma (STS) necessitates surveillance in follow-up. The objective of this study was to determine the frequency/timing of metastasis and local recurrence following treatment for soft tissue sarcoma, and to use these data to justify...

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Bibliographic Details
Published in:Annals of surgical oncology Vol. 27; no. 6; pp. 2033 - 2041
Main Authors: Wilson, David A. J., Gazendam, Aaron, Visgauss, Julia, Perrin, David, Griffin, Anthony M., Chung, Peter W., Catton, Charles N., Shultz, David, Ferguson, Peter C., Wunder, Jay S.
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01.06.2020
Springer Nature B.V
Subjects:
Adult
Aged
Diagnostic Imaging
Disease Progression
Disease-Free Survival
Evidence-Based Medicine
Extremities - pathology
Extremities - surgery
Female
Follow-Up Studies
Humans
Incidence
Kaplan-Meier Estimate
Male
Medicine
Medicine & Public Health
Metastases
Metastasis
Middle Aged
Neoplasm Grading
Neoplasm Metastasis - diagnosis
Neoplasm Recurrence, Local - diagnosis
Oncology
Predictive Value of Tests
Retrospective Studies
Sarcoma
Sarcoma - diagnostic imaging
Sarcoma - pathology
Sarcoma - surgery
Soft tissue sarcoma
Surgery
Surgical Oncology
Time Factors
Tumors
ISSN:1068-9265, 1534-4681, 1534-4681
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Summary:Purpose The risk of tumor recurrence after resection of soft tissue sarcoma (STS) necessitates surveillance in follow-up. The objective of this study was to determine the frequency/timing of metastasis and local recurrence following treatment for soft tissue sarcoma, and to use these data to justify an evidence-based follow-up schedule. Methods Utilizing a prospective database, a retrospective single center review was performed of all patients with minimum 2-year follow-up after resection of a localized extremity STS. Kaplan–Meier estimates were used to calculate the incidence of local recurrence and metastases on an annual basis for 10 years. Results We identified a total of 230 low-grade, 626 intermediate-grade and 940 high-grade extremity STS and a total of 721 events, 150 local recurrences and 571 metastases. Based on tumor size and grade, follow-up cohorts were developed that had similar metastatic risk. Using pre-determined thresholds for metastatic event, a follow-up schedule was established for each cohort. Conclusion Based on our results we recommend that patients with small low-grade tumors undergo annual follow-up for 5 years following definitive local treatment. Patients with large low-grade tumors, small intermediate-grade and small high-grade tumors should have follow-up every 6 months for the first 2 years, then yearly to 10 years. Only patients with large intermediate- or high-grade tumors require follow-up every 3 months for the first 2 years, then every 6 months for years 3–5, followed by annually until 10 years.
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ISSN:1068-9265
1534-4681
1534-4681
DOI:10.1245/s10434-020-08240-z