VOL. 95-B, No. 8, AUGUST 2013 1139  ONCOLOGY Outcome of soft-tissue sarcoma patients who were alive and event-free more than five years after initial treatment T. Nakamura, R. J. Grimer, S. R. Carter, R. M. Tillman, A. Abudu, L. Jeys, A. Sudo From The Royal Orthopaedic Hospital, Birmingham, United Kingdom  T. Nakamura, MD, PhD, Clinical Visitor  R. J. Grimer, FRCS, DCs, Consultant, Professor  S. R. Carter, FRCS, Consultant  R. M. Tillman, FRCS, Consultant  A. Abudu, FRCS, Consultant  L. Jeys, FRCS, Consultant The Royal Orthopaedic Hospital, Oncology Service, Bristol Road South, Birmingham B31 2AP, UK.  A. Sudo, MD, PhD, Professor Mie University Graduate School of Medicine, Department of Orthopaedic Surgery, Edobashi 2-174, Tsu- city, Mie 514-8507, Japan. Correspondence should be sent to Dr T. Nakamura; e-mail: tomoki66@clin.medic.mie-u. ac.jp ©2013 The British Editorial Society of Bone & Joint Surgery doi:10.1302/0301-620X.95B8. 31379 $2.00 Bone Joint J 2013;95-B:1139–43. Received 28 November 2012; Accepted after revision 10 April 2013 We evaluated the risk of late relapse and further outcome in patients with soft-tissue sarcomas who were alive and event-free more than five years after initial treatment. From our database we identified 1912 patients with these pathologies treated between 1980 and 2006. Of these 1912 patients, 603 were alive and event-free more than five years after initial treatment and we retrospectively reviewed them. The mean age of this group was 48 years (4 to 94) and 340 were men. The mean follow-up was 106 months (60 to 336). Of the original cohort, 582 (97%) were alive at final follow-up. The disease-specific survival was 96.4% (95% confidence interval (CI) 94.4 to 98.3) at ten years and 92.9% (95% CI 89 to 96.8) at 15 years. The rate of late relapse was 6.3% (38 of 603). The ten- and 15-year event-free rates were 93.2% (95% CI 90.8 to 95.7) and 86.1% (95% CI 80.2 to 92.1), respectively. Multivariate analysis showed that tumour size and tumour grade remained independent predictors of events. In spite of further treatment, 19 of the 38 patients died of sarcoma. The three- and five-year survival rates after the late relapse were 56.2% (95% CI 39.5 to 73.3) and 43.2% (95% CI 24.7 to 61.7), respectively, with a median survival time of 46 months. Patients with soft-tissue sarcoma, especially if large, require long-term follow-up, especially as they have moderate potential to have their disease controlled. Cite this article: Bone Joint J 2013;95-B:1139–43. The overall survival rate of patients with all stages of soft-tissue sarcoma remains between 50% and 60%. 1 Despite a complete surgical resection having being performed, patients with soft-tissue sarcomas may still develop dis- tant metastases and recurrences at the site of origin. The majority of patients who relapse after their primary management do so within the first two years, and more than 85% to 90% relapse within five years. 2-7 In contrast, other authors suggest these patients have a high incidence of relapse greater than five years since the initial treatment (‘late relapse’), as reflected in the difference between five- and ten-year event-free survival. 5,6 However, few studies have evaluated the occurrence of late relapse and subsequent outcome in patients who remain disease-free for at five years after the initial treatment. 8 We have investigated this latter subject and to examined the prognostic factors associated with event-free survival. Patients and Methods From our database we identified 1912 patients with a histological diagnosis of soft-tissue sar- coma treated between 1980 and 2006. Patients who presented with recurrent disease, distant metastases at diagnosis or who were referred for a second opinion were excluded from the study. Of 1912 patients, 589 had relapsed within five years after the initial treatment (of these, 446 (75.7%) developed problems within two years), and were excluded. A further 720 patients did not complete the five-year fol- low-up: some had died of other causes, and most did not live in our area. The remaining 603 patients were alive and event-free more than five years after the initial treatment. The mean age of this group was 48 years (4 to 94) and 340 were men. Among the 603 patients who comprised the study cohort the mean follow-up was 106 months (median 97; 60 to 336). All patients had pre-treatment staging with a lung CT scan to rule out the presence of metastases. The his- topathological diagnosis and tumour grade of each patient was determined by independent experienced musculoskeletal pathologists using the French Federation of Cancer Centres Sarcoma Group (FNCLCC) grading system. 9 Using the American Joint Committee on Can- cer (AJCC) classification, 10 tumours were defined as: 1) superficial (located exclusively above the superficial fascia without invasion); 2) deep (located either exclusively beneath the superficial fascia, superficial to the fascia with