Soft Tissue Sarcoma of Lower Extremity: Functional Outcome and Quality of Life

Gilber Kask, Jussi P Repo, Erkki J Tukiainen, Carl Blomqvist, Ian Barner-Rasmussen, Gilber Kask, Jussi P Repo, Erkki J Tukiainen, Carl Blomqvist, Ian Barner-Rasmussen

Abstract

Background: Few studies have focused on patient-related factors in analyzing long-term functional outcome and health-related quality of life (HRQoL) in patients with postoperative lower extremity soft tissue sarcoma (STS).

Objective: The purpose of this study was to investigate factors associated with postoperative functional outcome and HRQoL in patients with lower extremity STS.

Methods: This cross-sectional study was performed in a tertiary referral center using the Toronto Extremity Salvage Score (TESS), Quality-of-Life Questionnaire (QLQ)-C30 and 15 Dimension (15D) measures. Functional outcome and HRQoL data were collected prospectively. All patients were treated by a multidisciplinary team according to a written treatment protocol.

Results: A total of 141 patients who had undergone limb-salvage surgery were included. Depending on the outcome measure used, 19-51% of patients were completely asymptomatic and 13-14% of patients had an unimpaired HRQoL. The mean score for TESS, 15D mobility score, and QLQ-C30 Physical Functioning scale were 86, 0.83, and 75, respectively, while the mean score for 15D was 0.88, and 73 for QLQ-C30 QoL. Lower functional outcome was statistically significantly associated with higher age, higher body mass index (BMI), and the need for reconstructive surgery and radiotherapy, while lower HRQoL was statistically significantly associated with higher age, higher BMI, and reconstructive surgery.

Conclusion: Functional outcome and HRQoL were generally high in this cross-sectional study of patients with STS in the lower extremity. Both tumor- and treatment-related factors had an impact but patient-related factors such as age and BMI were the major determinants of both functional outcome and HRQoL.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow of patient recruitment. STS soft tissue sarcoma

References

    1. Toro JR, Travis LB, Wu HJ, et al. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978–2001: An analysis of 26,758 cases. Int J Cancer. 2006;119:2922–2930. doi: 10.1002/ijc.22239.
    1. American Society of Clinical Oncology. Sarcoma, Soft Tissue: Introduction.
    1. Kask G, Barner-Rasmussen I, Repo JP, et al. Functional Outcome Measurement in Patients with Lower-Extremity Soft Tissue Sarcoma: A Systematic Literature Review. Ann Surg Oncol. 2019;26(13):4707–4722. doi: 10.1245/s10434-019-07698-w.
    1. Saebye C, Fugloe HM, Nymark T, et al. Factors associated with reduced functional outcome and quality of life in patients having limb-sparing surgery for soft tissue sarcomas - a national multicenter study of 128 patients. Acta Oncol. 2017;56:239–244. doi: 10.1080/0284186X.2016.1268267.
    1. Podleska LE, Kaya N, Farzaliyev F, et al. Lower limb function and quality of life after ILP for soft-tissue sarcoma. World J Surg Oncol. 2017;15:84. doi: 10.1186/s12957-017-1150-3.
    1. Davidson D, Barr RD, Riad S, et al. Health-related quality of life following treatment for extremity soft tissue sarcoma. J Surg Oncol. 2016;114:821–827. doi: 10.1002/jso.24424.
    1. Davis AM, Sennik S, Griffin AM, et al. Predictors of functional outcomes following limb salvage surgery for lower-extremity soft tissue sarcoma. J Surg Oncol. 2000;73:206–211. doi: 10.1002/(SICI)1096-9098(200004)73:4<206::AID-JSO4>;2-5.
    1. Houdek MT, Hevesi M, Griffin AM, et al. Morbid Obesity Is Associated With an Increased Risk of Wound Complications and Infection After Lower Extremity Soft-tissue Sarcoma Resection. J Am Acad Orthop Surg. 2019;27:807–815. doi: 10.5435/JAAOS-D-18-00536.
    1. Davis AM, Wright JG, Williams JI, et al. Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res. 1996;5:508–516. doi: 10.1007/BF00540024.
    1. Wf E. Modification of the system for functional evaluation in the surgical management of musculoskeletal tumours. In: Enneking WF, editor. Limb Salvage in Musculoskeletal Oncology. New York, NY: Churchill Livingstone; 1987.
    1. Davis AM. Functional outcome in extremity soft tissue sarcoma. Semin Radiat Oncol. 1999;9:360–368. doi: 10.1016/S1053-4296(99)80030-7.
    1. Furtado S, Errington L, Godfrey A, et al. Objective clinical measurement of physical functioning after treatment for lower extremity sarcoma: A systematic review. Eur J Surg Oncol. 2017;43:968–993. doi: 10.1016/j.ejso.2016.10.002.
    1. Tang MH, Pan DJ, Castle DJ, Choong PF. A systematic review of the recent quality of life studies in adult extremity sarcoma survivors. Sarcoma. 2012;2012:171342. doi: 10.1155/2012/171342.
    1. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–376. doi: 10.1093/jnci/85.5.365.
    1. Luckett T, King MT, Butow PN, et al. Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: issues, evidence and recommendations. Ann Oncol. 2011;22:2179–2190. doi: 10.1093/annonc/mdq721.
    1. Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med. 2001;33:328–336. doi: 10.3109/07853890109002086.
    1. Ogura K, Uehara K, Akiyama T, et al. Minimal clinically important differences in Toronto Extremity Salvage Score for patients with lower extremity sarcoma. J Orthop Sci. 2020;25(2):315–318. doi: 10.1016/j.jos.2019.03.022.
    1. Alanne S, Roine RP, Rasanen P, et al. Estimating the minimum important change in the 15D scores. Qual Life Res. 2015;24:599–606. doi: 10.1007/s11136-014-0787-4.
    1. Osoba D, Rodrigues G, Myles J, et al. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16:139–144. doi: 10.1200/JCO.1998.16.1.139.
    1. Broders AC, Hargrave R, Meyerding HW. Pathologic features of soft tissue fibrosarcoma with special reference to the grading of its malignancy. Surg Gynaecol Obstet. 1939;69:267–280.
    1. Angervall L, Kindblom LG. Principles for pathologic-anatomic diagnosis and classification of soft-tissue sarcomas. Clin Orthop Relat Res. 1993;289:9–18.
    1. Pollock RE, Karnell LH, Menck HR, Winchester DP. The National Cancer Data Base report on soft tissue sarcoma. Cancer. 1996;78:2247–2257. doi: 10.1002/(SICI)1097-0142(19961115)78:10<2247::AID-CNCR29>;2-Y.
    1. World Health Organization . Global status report on noncommunicable diseases in 2014. Geneva: World Health Organization; 2014.
    1. Davis AM, O’Sullivan B, Bell RS, et al. Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol. 2002;20:4472–4477. doi: 10.1200/JCO.2002.03.084.
    1. Heaver C, Isaacson A, Gregory JJ, et al. Patient factors affecting the Toronto extremity salvage score following limb salvage surgery for bone and soft tissue tumors. J Surg Oncol. 2016;113:804–810. doi: 10.1002/jso.24247.
    1. Banierink H, Reininga IHF, Heineman E, et al. Long-term physical functioning and quality of life after pelvic ring injuries. Arch Orthop Trauma Surg. 2019;139:1225–1233. doi: 10.1007/s00402-019-03170-2.
    1. Houdek MT, Griffin AM, Ferguson PC, Wunder JS. Morbid Obesity Increases the Risk of Postoperative Wound Complications, Infection, and Repeat Surgical Procedures Following Upper Extremity Limb Salvage Surgery for Soft Tissue Sarcoma. Hand (N Y) 2019;14:114–120. doi: 10.1177/1558944718797336.
    1. Weschenfelder W, Gast-Froehlich S, Spiegel C, et al. Factors influencing quality of life, function, reintegration and participation after musculoskeletal tumour operations. BMC Cancer. 2020;20:351. doi: 10.1186/s12885-020-06837-x.
    1. Gerrand CH, Wunder JS, Kandel RA, et al. The influence of anatomic location on functional outcome in lower-extremity soft-tissue sarcoma. Ann Surg Oncol. 2004;11:476–482. doi: 10.1245/ASO.2004.07.016.
    1. Gotzl R, Sterzinger S, Semrau S, et al. Patient’s quality of life after surgery and radiotherapy for extremity soft tissue sarcoma: a retrospective single-center study over ten years. Health Qual Life Outcomes. 2019;17:170. doi: 10.1186/s12955-019-1236-4.
    1. Harati K, Kirchhoff P, Behr B, et al. Soft tissue sarcomas of the distal lower extremities: A single-institutional analysis of the prognostic significance of surgical margins in 120 patients. Oncol Rep. 2016;36:863–870. doi: 10.3892/or.2016.4862.
    1. Townley WA, Mah E, O’Neill AC, et al. Reconstruction of sarcoma defects following pre-operative radiation: free tissue transfer is safe and reliable. J Plast Reconstr Aesthet Surg. 2013;66:1575–1579. doi: 10.1016/j.bjps.2013.06.029.
    1. Kang S, Han I, Kim S, et al. Outcomes after flap reconstruction for extremity soft tissue sarcoma: a case-control study using propensity score analysis. Eur J Surg Oncol. 2014;40:1101–1108. doi: 10.1016/j.ejso.2014.05.004.
    1. Pradhan A, Cheung YC, Grimer RJ, et al. Does the method of treatment affect the outcome in soft-tissue sarcomas of the adductor compartment? J Bone Joint Surg Br. 2006;88:1480–1486. doi: 10.1302/0301-620X.88B11.17424.
    1. Stoeckle E, Michot A, Rigal L, et al. The risk of postoperative complications and functional impairment after multimodality treatment for limb and trunk wall soft-tissue sarcoma: Long term results from a monocentric series. Eur J Surg Oncol. 2017;43:1117–1125. doi: 10.1016/j.ejso.2017.01.018.
    1. Slump J, Hofer SOP, Ferguson PC, et al. Flap choice does not affect complication rates or functional outcomes following extremity soft tissue sarcoma reconstruction. J Plast Reconstr Aesthet Surg. 2018;71:989–996. doi: 10.1016/j.bjps.2018.04.002.
    1. Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D. Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer. 2004;91:1012–1014. doi: 10.1038/sj.bjc.6602104.
    1. Hudgens S, Forsythe A, Kontoudis I, et al. Evaluation of Quality of Life at Progression in Patients with Soft Tissue Sarcoma. Sarcoma. 2017;2017:2372135. doi: 10.1155/2017/2372135.
    1. Saebye C, Amidi A, Keller J, et al. Changes in Functional Outcome and Quality of Life in Soft Tissue Sarcoma Patients within the First Year after Surgery: A Prospective Observational Study. Cancers (Basel) 2020;12(2):463. doi: 10.3390/cancers12020463.
    1. Rivard JD, Puloski SS, Temple WJ, et al. Quality of life, functional outcomes, and wound complications in patients with soft tissue sarcomas treated with preoperative chemoradiation: a prospective study. Ann Surg Oncol. 2015;22:2869–2875. doi: 10.1245/s10434-015-4490-7.

Source: PubMed

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