Primary Adult Soft Tissue Sarcoma in Iran: A Multivariate Analysis of Short and Long-term Survival

Background: surgery is the main treatment for soft tissue sarcoma (sts). however, despite complete excision of the tumor, surgery alone is infrequently curative. analysis of the causes of failure and of prognostic factors is warranted to ascertain treatment orientation. methods: records of the central hospital of the cancer institute of iran for 950 patients with sts during the period 1991-2002 were identified. the following clinicopathologic factors were correlated with the endpoint studied: patient age, gender, and duration of symptoms before diagnosis, tumor location, size and depth, histology subtype, grade and stage, response to chemotherapy, status of pathologic surgical margins and metastatic presentation. in total, 839 adult patients were included in the assessment. results: the mean/median age was 41/39 (16-103). the male/female ratio was 3/2. ninety-five percent of the patients had tumors located deep to the muscular fascia. tumor grade was based on three criteria: tumor differentiation, necrosis and mitosis. tumor size and grade were used to determine disease stage. mean follow-up time was 48 months. the 5 year overall survival (os) was 26%. independent predictors of os were age, grade, stage, margin of surgery and metastatic presentation. eighty percent of recurrences developed within 2 years of initial resection. grade was strongly associated with early relapse-free survival (rfs) and the margin of surgery with late rfs. chemotherapy in the adjuvant setting did not have a significant influence on os. but response to palliative and neoadjuvant chemotherapy especially with ifosfamide and adriamycin had strong association with long-term survival (p=.0001). conclusion: despite aggressive surgery, large and high-grade tumors have poor prognoses. in our study, response to chemotherapy was a major prognostic factor for os. it probably means that advanced sarcoma is potentially curable for a subset of patients treated with multimodality therapy included chemotherapy. multicenter trials of neoadjuvant chemotherapy are warranted