Background: Tumor rupture is considered a R2 resection and is not uncommonly encountered when attempting a tumor-free resection, especially in high-risk soft tissue sarcomas. The predictive value of tumor rupture for metastasis development and its impact on metastasis-free interval needs to be investigated and further taken into consideration in preoperative planning.
Methods: From January 1993 to December 2009, 276 cases of stage III soft tissue sarcoma were collected from Tianjin Medical University Cancer Institution and Hospital. The clinical characteristics and histopathological features were retrospectively reviewed and analyzed with treatment modalities, tumor rupture status for disease-specific survival (DSS), distant recurrence-free survival (DRFS), and metastasis-free interval (MFI).
Results: Of the 276 patients who underwent surgical resection of their tumors, 53 patients experienced a tumor rupture. Median follow-up period was 68 months. Two-year and 5-year overall survival rates for patients with tumor rupture were 46 and 27% compared with 76 and 57% for patients without tumor rupture, respectively. Median overall survival for patients with tumor rupture was 24 months compared with 56 months for those without. In multivariate analysis, FNCLCC grade III, tumor>10 cm, tumor rupture, and no chemotherapy were associated with decreased DSS and DRFS. Tumor rupture predicted shorter MFI of 5 months compared with 15 months of those without tumor rupture.
Conclusions: Tumor rupture was associated with decreased DSS and DRFS in stage III sarcomas. It also predicted early metastasis and directly impacted patient's survival. Additional procedures should be investigated to avoid tumor rupture.