Outcomes for Soft-Tissue Sarcoma in 8249 Cases from a Large State Cancer Registry Juan C. Gutierrez, M.D., Eduardo A. Perez, M.D., Dido Franceschi, M.D., Frederick L. Moffat, Jr., M.D., Alan S. Livingstone, M.D., and Leonidas G. Koniaris, M.D. 1 DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida Submitted for publication January 30, 2007 Background and objectives. To date, outcome re- ports for soft-tissue sarcoma (STS) have largely been limited to single or paired institutional series. To more accurately elucidate population-based outcomes and prognostic factors associated with STS, a large cancer registry was examined. Methods. STS arising in the Florida Cancer Data System were examined (1981–2004). Results. A total of 8249 patients were identified, the calculated annual incidence of sarcoma being approx- imately 38 cases per million in 2003. The tumor histol- ogies among these patients were leiomyosarcoma and gastrointestinal stromal tumor (LMS/GIST) (43.5%), malignant fibrous histiocytoma (MFH) (31.5%), liposar- coma (19.0%), and fibrosarcoma (6.0%). Tumors were situated in the extremities (30.7%), truncal or visceral locations (50.4%), retroperitoneum (11.7%), and head or neck (7.2%). Thirty-three percent of lesions were over 10 cm in greatest dimension, while 50.2% were classified as high grade. Median overall survival was 25 months. Superior survival was observed for liposar- comas and fibrosarcomas as compared to MFH and LMS/GIST (P < 0.001). Retroperitoneal and truncal sarcomas had a more ominous prognosis than did other sites (P < 0.001). Multivariate analysis of pre- treatment variables demonstrated that increasing age, male gender, non-Caucasian race, advanced stage, and a truncal or retroperitoneal location were each inde- pendently associated with lower survival. Histological subtype was also an independent predictor of out- come. Surgical resection and radiation therapy were the only treatment variables shown to improve survival. Conclusions. Histological subtype, tumor site, and stage are independent prognostic factors in STS. Sur- gical resection and radiotherapy are unique among treatment modalities in association with a significant survival benefit. © 2007 Elsevier Inc. All rights reserved. Key Words: soft-tissue sarcoma; histological sub- types; surgery; radiotherapy; chemotherapy; prognos- tic factors. INTRODUCTION Soft-tissue sarcomas (STS) are uncommon, biologi- cally and histologically heterogeneous neoplasms aris- ing from mesenchymal tissues throughout the body [1]. Approximately 9420 cases were diagnosed in the United States in 2005, accounting for less than 1% of all new malignancies [2– 4]. Traditionally, the main- stay of treatment for STS has been surgical resection with tumor-free margins, adjuvant or neoadjuvant che- motherapy, and/or radiation coming into their own with the advent of limb-, tissue-, and function-sparing surgery [5–7]. Tumor size, grade, stage, and surgical margin status are identified in single-institution series as the most important prognostic factors in these tu- mors [8 –11]. To date, treatment strategy has been determined more by anatomical site than by histolog- ical subtype [12]. Only recently have investigators fo- cused significantly on the influence of histology on prognosis [13, 14]. The sarcoma literature is dominated by retrospective series from single institutions or pooled data from two or more institutions with major tertiary referral prac- tices. Such series are limited by small sample size and selection bias in favor of advanced, recurrent, or oth- erwise complicated sarcomas. These factors may skew survival and other treatment outcomes in this uncom- mon, heterogeneous group of tumors. We therefore an- 1 To whom correspondence and reprint requests should be ad- dressed at University of Miami School of Medicine, 3550 Sylvester Comprehensive Cancer Center, 1475 NW 12th Avenue, Miami, FL 33136. E-mail: lkoniaris@med.miami.edu. Journal of Surgical Research 141, 105–114 (2007) doi:10.1016/j.jss.2007.02.026 105 0022-4804/07 $32.00 © 2007 Elsevier Inc. All rights reserved.