Predictors of residual disease after unplanned excision of soft tissue sarcomas

Alicia A. Gingrich, Alexandra Elias, Chia Yuan Michael Lee, Yves Paul N Nakache, Chin-Shang Li, Dhruvil R. Shah, Robert D Boutin, Robert J Canter

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Unplanned excision of soft tissue sarcomas (STS) is an important quality of care issue given the morbidity related to tumor bed excision. Since not all patients harbor residual disease at the time of reexcision, we sought to determine predictors of residual STS following unplanned excision. Methods We identified 76 patients from a prospective database (January 1, 2008-September 30, 2014) who received a diagnosis of primary STS following unplanned excision on the trunk or extremities. We used univariable and multivariable analyses to evaluate predictors of residual STS as the primary endpoint. We calculated the sensitivity, specificity, and accuracy of interval magnetic resonance imaging (MRI) to predict residual sarcoma at reexcision. Results Mean age was 52 y, and 63.2% were male. 50% had fragmented unplanned excision. Among patients undergoing reexcision, residual STS was identified in 70%. On univariable analysis, MRI showing gross disease and fragmented excision were significant predictors of residual STS (odds ratio, 10.59; 95% CI, 2.14-52.49; P = 0.004 and odds ratio, 3.61; 95% CI, 1.09-11.94; P = 0.035, respectively). On multivariable analysis, tumor size predicted distant recurrence and overall survival. When we combined equivocal and positive MRI, the sensitivity and specificity of MRI for predicting residual STS were 86.7% (95% CI, 73.2%-95.0%) and 57.9% (95% CI, 33.5%-79.8%), with an overall accuracy of 78.1% (95% CI, 66.0%-87.5%). Conclusions About 70% of patients undergoing repeat excision after unplanned excision of STS harbor residual sarcoma. Although interval MRI and fragmented excision appear to be the most significant predictors of residual STS, the accuracy of MRI remains modest, especially given the incidence of equivocal MRI.

Original languageEnglish (US)
Pages (from-to)26-32
Number of pages7
JournalJournal of Surgical Research
Volume208
DOIs
StatePublished - Feb 1 2017

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Sarcoma
Magnetic Resonance Imaging
Odds Ratio
Sensitivity and Specificity
Quality of Health Care
Neoplasms
Extremities
Databases
Morbidity
Recurrence
Survival
Incidence

Keywords

  • MRI
  • Residual disease
  • Soft tissue sarcoma
  • Unplanned excision

ASJC Scopus subject areas

  • Surgery

Cite this

Predictors of residual disease after unplanned excision of soft tissue sarcomas. / Gingrich, Alicia A.; Elias, Alexandra; Michael Lee, Chia Yuan; Nakache, Yves Paul N; Li, Chin-Shang; Shah, Dhruvil R.; Boutin, Robert D; Canter, Robert J.

In: Journal of Surgical Research, Vol. 208, 01.02.2017, p. 26-32.

Research output: Contribution to journalArticle

Gingrich, Alicia A. ; Elias, Alexandra ; Michael Lee, Chia Yuan ; Nakache, Yves Paul N ; Li, Chin-Shang ; Shah, Dhruvil R. ; Boutin, Robert D ; Canter, Robert J. / Predictors of residual disease after unplanned excision of soft tissue sarcomas. In: Journal of Surgical Research. 2017 ; Vol. 208. pp. 26-32.
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abstract = "Background Unplanned excision of soft tissue sarcomas (STS) is an important quality of care issue given the morbidity related to tumor bed excision. Since not all patients harbor residual disease at the time of reexcision, we sought to determine predictors of residual STS following unplanned excision. Methods We identified 76 patients from a prospective database (January 1, 2008-September 30, 2014) who received a diagnosis of primary STS following unplanned excision on the trunk or extremities. We used univariable and multivariable analyses to evaluate predictors of residual STS as the primary endpoint. We calculated the sensitivity, specificity, and accuracy of interval magnetic resonance imaging (MRI) to predict residual sarcoma at reexcision. Results Mean age was 52 y, and 63.2{\%} were male. 50{\%} had fragmented unplanned excision. Among patients undergoing reexcision, residual STS was identified in 70{\%}. On univariable analysis, MRI showing gross disease and fragmented excision were significant predictors of residual STS (odds ratio, 10.59; 95{\%} CI, 2.14-52.49; P = 0.004 and odds ratio, 3.61; 95{\%} CI, 1.09-11.94; P = 0.035, respectively). On multivariable analysis, tumor size predicted distant recurrence and overall survival. When we combined equivocal and positive MRI, the sensitivity and specificity of MRI for predicting residual STS were 86.7{\%} (95{\%} CI, 73.2{\%}-95.0{\%}) and 57.9{\%} (95{\%} CI, 33.5{\%}-79.8{\%}), with an overall accuracy of 78.1{\%} (95{\%} CI, 66.0{\%}-87.5{\%}). Conclusions About 70{\%} of patients undergoing repeat excision after unplanned excision of STS harbor residual sarcoma. Although interval MRI and fragmented excision appear to be the most significant predictors of residual STS, the accuracy of MRI remains modest, especially given the incidence of equivocal MRI.",
keywords = "MRI, Residual disease, Soft tissue sarcoma, Unplanned excision",
author = "Gingrich, {Alicia A.} and Alexandra Elias and {Michael Lee}, {Chia Yuan} and Nakache, {Yves Paul N} and Chin-Shang Li and Shah, {Dhruvil R.} and Boutin, {Robert D} and Canter, {Robert J}",
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T1 - Predictors of residual disease after unplanned excision of soft tissue sarcomas

AU - Gingrich, Alicia A.

AU - Elias, Alexandra

AU - Michael Lee, Chia Yuan

AU - Nakache, Yves Paul N

AU - Li, Chin-Shang

AU - Shah, Dhruvil R.

AU - Boutin, Robert D

AU - Canter, Robert J

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background Unplanned excision of soft tissue sarcomas (STS) is an important quality of care issue given the morbidity related to tumor bed excision. Since not all patients harbor residual disease at the time of reexcision, we sought to determine predictors of residual STS following unplanned excision. Methods We identified 76 patients from a prospective database (January 1, 2008-September 30, 2014) who received a diagnosis of primary STS following unplanned excision on the trunk or extremities. We used univariable and multivariable analyses to evaluate predictors of residual STS as the primary endpoint. We calculated the sensitivity, specificity, and accuracy of interval magnetic resonance imaging (MRI) to predict residual sarcoma at reexcision. Results Mean age was 52 y, and 63.2% were male. 50% had fragmented unplanned excision. Among patients undergoing reexcision, residual STS was identified in 70%. On univariable analysis, MRI showing gross disease and fragmented excision were significant predictors of residual STS (odds ratio, 10.59; 95% CI, 2.14-52.49; P = 0.004 and odds ratio, 3.61; 95% CI, 1.09-11.94; P = 0.035, respectively). On multivariable analysis, tumor size predicted distant recurrence and overall survival. When we combined equivocal and positive MRI, the sensitivity and specificity of MRI for predicting residual STS were 86.7% (95% CI, 73.2%-95.0%) and 57.9% (95% CI, 33.5%-79.8%), with an overall accuracy of 78.1% (95% CI, 66.0%-87.5%). Conclusions About 70% of patients undergoing repeat excision after unplanned excision of STS harbor residual sarcoma. Although interval MRI and fragmented excision appear to be the most significant predictors of residual STS, the accuracy of MRI remains modest, especially given the incidence of equivocal MRI.

AB - Background Unplanned excision of soft tissue sarcomas (STS) is an important quality of care issue given the morbidity related to tumor bed excision. Since not all patients harbor residual disease at the time of reexcision, we sought to determine predictors of residual STS following unplanned excision. Methods We identified 76 patients from a prospective database (January 1, 2008-September 30, 2014) who received a diagnosis of primary STS following unplanned excision on the trunk or extremities. We used univariable and multivariable analyses to evaluate predictors of residual STS as the primary endpoint. We calculated the sensitivity, specificity, and accuracy of interval magnetic resonance imaging (MRI) to predict residual sarcoma at reexcision. Results Mean age was 52 y, and 63.2% were male. 50% had fragmented unplanned excision. Among patients undergoing reexcision, residual STS was identified in 70%. On univariable analysis, MRI showing gross disease and fragmented excision were significant predictors of residual STS (odds ratio, 10.59; 95% CI, 2.14-52.49; P = 0.004 and odds ratio, 3.61; 95% CI, 1.09-11.94; P = 0.035, respectively). On multivariable analysis, tumor size predicted distant recurrence and overall survival. When we combined equivocal and positive MRI, the sensitivity and specificity of MRI for predicting residual STS were 86.7% (95% CI, 73.2%-95.0%) and 57.9% (95% CI, 33.5%-79.8%), with an overall accuracy of 78.1% (95% CI, 66.0%-87.5%). Conclusions About 70% of patients undergoing repeat excision after unplanned excision of STS harbor residual sarcoma. Although interval MRI and fragmented excision appear to be the most significant predictors of residual STS, the accuracy of MRI remains modest, especially given the incidence of equivocal MRI.

KW - MRI

KW - Residual disease

KW - Soft tissue sarcoma

KW - Unplanned excision

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