Recurrence Of Soft Tissue Sarcomas After Surgical Treatment At The Kenyatta National Hospital
Background Soft tissues sarcomas are the most frequent sarcomas. They represent a rare group of solid mesenchymal tumours with high rates of morbidity and mortality that are influenced by patient, tumour, and treatment factors .. Large series report recurrence rates of between 20-25 %, usually within 2-3 years after surgical treatment. In Africa, many of the patients present late, and have to travel long distances to treatment centres. Access to adjuvant therapy is not guaranteed either. Consequently, the patterns and rates of recurrences may differ from quoted literature. Purpose/aim of study To determine the pattern and factors associated with recurrence III patients treated surgically for soft tissue sarcomas at the Kenyatta National Hospital. Study design A five and a half years retrospective study between January 2003 and June 2007 and a six months prospective follow-up arm between July 2008 and March 2009. Patient and methods Retrospectively, as well as prospectively collected data from a population of patients selected from all those surgically treated at the Kenyatta National Hospital, between January 2003 and March 2009, for soft tissue sarcomas were reviewed. Primary data included demographic variables (age and sex), clinical variables (duration of symptoms, anatomical distribution, radiological tests undertaken, adjuvant therapy given) and pathological variables (tumour type, size, grade stage and surgical margins status). The outcome variables were tumour recurrence and death. The variables that were studied to determine a relationship with recurrence were: patient age, tumour site, grade, histological type, microscopic involvement of surgical margins by tumour and whether or not adjuvant chemotherapy and / or radiotherapy were instituted. Data Analysis Univariate analyses were used to determine the influence of each variable on the outcome. P<0.05 was considered significant. Results Mean age was 32.52±18.17 years. The age group distribution was bimodal with peaks at 10-19 years and 40-49 years. The male/ female sex ratio was 0.97:1. The mean duration of symptoms was 110.87±18.75 months. The extremities had the most number of cases (62%). Fibrosarcoma was the most common histological type (36.0%) and the mean tumour size was 13.0 ±7.36 em. Most (44.7%) patients presented with high grade tumours and 78.0 % of the patients presented with a recurrence. Most of the recurrences .. (71.7%) occurred within the first year of treatment. Failure to get adjuvant therapy (p<0.001), tumour size >5cm (p=0.02), advanced stage (III and IV) (p<0.001), and positive microscopic margins (p<0.001) were adverse prognostic factors for getting a recurrence. Presentation with a recurrent tumour (p<0.027), failure to receive adjuvant therapy (p<0.001), advanced stages (III and IV) (p<0.001), positive microscopic margins (p<0.001), and high grade tumours (p<0.001), were all adverse prognostic factors for death. Patients who underwent wide, radical excisions or amputations were less likely to die than those who underwent intra-lesional or marginal excisions (p=0.05). For patients who received adjuvant therapy, chemotherapy, compared to radiotherapy, was an adverse factor for death (p=0.003). Intralesional and marginal excisions, versus amputations/wide or radical excisions (p=0.05) and distant recurrence in the lungs/chest were also adverse factors for death (p=0.001). Conclusions Advanced stages of soft tissue sarcomas, higher histological grades, positive microscopic surgical margins, and failure to receive adjuvant treatment influenced both recurrence and mortality after surgical treatment. In addition a tumour> 5cm was a negative prognostic factor for recurrence, while presentation with a primary recurrent tumour and intralesional or marginal tumour excisions were negative prognostic factors for death. Better outcome results from surgical treatment of soft tissue sarcomas may be achieved if efforts to treat them earlier were to be a reality.