Risk factors for local recurrence and @entity3 in soft tissue XXXX of the extremity.

@entity1 @entity66 @entity242 @entity5 @entity3
OBJECTIVES: We reviewed our institution's experience in treating soft tissue @entity242 of the extremity to identify factors associated with local recurrence, @entity3 , and overall survival, to identify @entity1 who may benefit from intensification of therapy. METHODS: A retrospective analysis was performed for @entity1 who underwent both limb-sparing surgery and external beam radiotherapy for extremity @entity242 . Those who had gross @entity66 or who presented with recurrent or metastatic disease were excluded. The Kaplan-Meier product limit and multivariate Cox regression were used to estimate local failure-free probability, distant failure-free probability, and overall survival along with associations with @entity1 , @entity5 , and treatment characteristics. RESULTS: One hundred eighty-eight @entity1 were included in the analysis. Twenty-five (13%) and 46 (24%) experienced local and distant recurrence, respectively. @entity1 with high/intermediate-grade @entity5 [hazard ratio (HR)=5.63, 95% confidence interval (CI): 1.27-24.89, P=0.023] or with multifocally positive margins (HR=4.27, 95% CI: 1.20-15.24, P=0.026) were more likely to fail locally. Those with a preceding local recurrence (HR=8.58, 95% CI: 3.87-19.04, P<0.0001), high/intermediate-grade @entity5 (HR=5.68, 95% CI: 1.28-25.25, P=0.023), or no secondary reexcision (HR=2.5, 95% CI: 1.09-5.74, P=0.031) were more likely to develop @entity3 . @entity1 with local recurrence (HR=3.6, 95% CI: 1.77-7.29, P<0.001), @entity3 (HR=16.0, 95% CI: 7.93-32.31, P<0.0001), or without secondary reexcision (HR=3.2, 95% CI: 1.27-8.09, P=0.014) had decreased overall survival. CONCLUSIONS: @entity1 whose @entity5 grade or margin status put them at high risk for local failure should be considered for intensification of therapy. Those with a local recurrence should be considered for increased surveillance or systemic therapy, as local failure is associated with subsequent @entity3 and decreased survival.
