Functional Outcome Measurement in Patients with Lower-Extremity Soft Tissue Sarcoma: A Systematic Literature Review

Gilber Kask, Ian Barner-Rasmussen, Jussi Petteri Repo, Magnus Kjäldman, Kaarel Kilk, Carl Blomqvist, Erkki Juhani Tukiainen, Gilber Kask, Ian Barner-Rasmussen, Jussi Petteri Repo, Magnus Kjäldman, Kaarel Kilk, Carl Blomqvist, Erkki Juhani Tukiainen

Abstract

Background: The importance of functional outcome (FO) in the treatment of patients with extremity soft tissue sarcoma (STS) has been increasingly recognized in the last three decades. This systematic review aimed to investigate how FO is measured in surgically treated lower-extremity STS patients.

Methods: A systematic search of PubMed, Web of Science, and Scopus was performed based on the PRISMA guidelines. The methodologic quality of the publications was measured using the MINORS tool. The results from the included studies examining measurement types, measures, and time of FO measurement were compiled. The FO pooled mean and standard deviation were calculated as a weighted average for the groups. The validity of the applied measures is reported.

Results: The literature search found 3461 publications, 37 of which met the inclusion criteria. The measurement types used were clinician-reported outcomes (n = 27), patient-reported outcomes (n = 20), and observer-reported outcomes (n = 2). The most frequently used measures were the Toronto Extremity Salvage Score (TESS) (n = 16) and the Musculoskeletal Tumor Society (MSTS) score 1993 (n = 12). The postoperative FO was relatively good. The pooled mean TESS and MSTS 1993 scores were respectively 83.3 and 86.2 (out of 100). Of the 10 previously reported measures, 3 provide validated FO scores. The methodologic quality of publications was generally low.

Conclusions: Based on this systematic review, several different methods exist for assessing FO in patients with lower-extremity sarcoma. The most frequently used measure is a validated TESS. The postoperative FO of patients with lower-extremity STS seems to increase to the preoperative baseline level during long-term follow-up evaluation.

Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram showing flow of studies retrieved for systematic review of functional outcome measurement in patients with lower-extremity soft tissue sarcoma
Fig. 2
Fig. 2
Pre- and postoperative TESS and MSTS 1993 pooled mean and SD results

References

    1. Davis AM, Bell RS, Badley EM, et al. Evaluating functional outcome in patients with lower extremity sarcoma. Clin Orthop Relat Res. 1999;90–100.
    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.
    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.
    1. Davis AM. Functional outcome in extremity soft tissue sarcoma. Semin Radiat Oncol. 1999;9:360–368.
    1. MacDermid JC, Grewal R, MacIntyre NJ. Using an evidence-based approach to measure outcomes in clinical practice. Hand Clin. 2009;25(97–111):vii.
    1. van Dam MS, Kok GJ, Munneke M, et al. Measuring physical activity in patients after surgery for a malignant tumour in the leg: the reliability and validity of a continuous ambulatory activity monitor. J Bone Joint Surg Br. 2001;83:1015–1019.
    1. Groundland JS, Ambler SB, Houskamp LD, et al. Surgical and functional outcomes after limb-preservation surgery for tumor in pediatric patients: a systematic review. JBJS Rev. 2016
    1. Wilson RJ, Freeman TH, Jr, Halpern JL, et al. Surgical outcomes after limb-sparing resection and reconstruction for pelvic sarcoma: a systematic review. JBJS Rev. 2018;6:e10.
    1. Winnette R, Hess LM, Nicol SJ, et al. The patient experience with soft tissue sarcoma: a systematic review of the literature. Patient. 2017;10:153–162.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–1012.
    1. Stephen Isaac WBM. Handbook in Research and Evaluation: A Collection of Principles, Methods, and Strategies Useful in the Planning, Design, and Evaluation of Studies in Education and the Behavioral Sciences. San Diego, CA: Educational and Industrial Testing Services; 1995.
    1. Center for Drug Evaluation and Research (CDER), Food and Drug Administration. Qualification Process for Drug Development Tools. Guidance document, 2014.
    1. Elwood M. Critical Appraisal of Epidemiological Studies and Clinical Trial. Oxford: Oxford University Press; 2007.
    1. Slim K, Nini E, Forestier D, et al. Methodological index for nonrandomized studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003;73:712–716.
    1. Smeeing DPJ, van der Ven DJC, Hietbrink F, et al. Surgical versus nonsurgical treatment for midshaft clavicle fractures in patients aged 16 years and older: a systematic review, meta-analysis, and comparison of randomized controlled trials and observational studies. Am J Sports Med. 2017;45:1937–1945.
    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.
    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.
    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.
    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.
    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.
    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.
    1. Chang EI, Nguyen AT, Hughes JK, et al. Optimization of free-flap limb salvage and maximizing function and quality of life following oncologic resection: 12-year experience. Ann Surg Oncol. 2016;23:1036–1043.
    1. Furtado S, Grimer RJ, Cool P, et al. Physical functioning, pain, and quality of life after amputation for musculoskeletal tumours: a national survey. Bone Joint J. 2015;97-B:1284–90.
    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.
    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.
    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.
    1. Kozawa E, Nishida Y, Nakashima H, et al. Foot sarcomas: factors affecting oncological and functional outcomes. Oncol Lett. 2012;3:82–88.
    1. Friedmann D, Wunder JS, Ferguson P, et al. Incidence and severity of lymphoedema following limb salvage of extremity soft tissue sarcoma. Sarcoma. 2011;2011:289673.
    1. Thacker MM, Potter BK, Pitcher JD, Temple HT. Soft tissue sarcomas of the foot and ankle: impact of unplanned excision, limb salvage, and multimodality therapy. Foot Ankle Int. 2008;29:690–698.
    1. Tsukushi S, Nishida Y, Sugiura H, et al. Results of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma in the lower extremity: comparison between only arterial and arterovenous reconstruction. J Surg Oncol. 2008;97:216–220.
    1. Hoy E, Granick M, Benevenia J, et al. Reconstruction of musculoskeletal defects following oncologic resection in 76 patients. Ann Plast Surg. 2006;57:190–194.
    1. Pardasaney PK, Sullivan PE, Portney LG, Mankin HJ. Advantage of limb salvage over amputation for proximal lower-extremity tumors. Clin Orthop Relat Res. 2006;444:201–208.
    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.
    1. Nelson AA, Frassica FJ, Gordon TA, Deune EG. Cost analysis of functional restoration surgery for extremity soft-tissue sarcoma. Plast Reconstr Surg. 2006;117:277–283.
    1. Thijssens KM, Hoekstra-Weebers JE, van Ginkel RJ, Hoekstra HJ. Quality of life after hyperthermic isolated limb perfusion for locally advanced extremity soft tissue sarcoma. Ann Surg Oncol. 2006;13:864–871.
    1. Davis AM, O’Sullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75:48–53.
    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.
    1. Rachbauer F, Sztankay A, Kreczy A, et al. High-dose-rate intraoperative brachytherapy (IOHDR) using flab technique in the treatment of soft tissue sarcomas. Strahlenther Onkol. 2003;179:480–485.
    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.
    1. Refaat Y, Gunnoe J, Hornicek FJ, Mankin HJ. Comparison of quality of life after amputation or limb salvage. Clin Orthop Relat Res. 2002;397:298–305.
    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.
    1. Davis AM, Devlin M, Griffin AM, et al. Functional outcome in amputation versus limb sparing of patients with lower-extremity sarcoma: a matched case-control study. Arch Phys Med Rehabil. 1999;80:615–618.
    1. Colterjohn NR, Davis AM, O’Sullivan B, et al. Functional outcome in limb-salvage surgery for soft tissue tumours of the foot and ankle. Sarcoma. 1997;1:67–74.
    1. Pitcher ME, Thomas JM. Functional compartmental resection for soft tissue sarcomas. Eur J Surg Oncol. 1994;20:441–445.
    1. Keus RB, Rutgers EJ, Ho GH, et al. Limb-sparing therapy of extremity soft tissue sarcomas: treatment outcome and long-term functional results. Eur J Cancer. 1994;30A:1459–1463.
    1. Moseley HS. An evaluation of two methods of limb salvage in extremity soft tissue sarcomas. Arch Surg. 1992;127:1169–73; discussion 1173–1164.
    1. Karasek K, Constine LS, Rosier R. Sarcoma therapy: functional outcome and relationship to treatment parameters. Int J Radiat Oncol Biol Phys. 1992;24:651–656.
    1. Robinson MH, Spruce L, Eeles R, et al. Limb function following conservation treatment of adult soft tissue sarcoma. Eur J Cancer. 1991;27:1567–1574.
    1. Stinson SF, DeLaney TF, Greenberg J, et al. Acute and long-term effects on limb function of combined modality limb-sparing therapy for extremity soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1991;21:1493–1499.
    1. Talbert ML, Zagars GK, Sherman NE, Romsdahl MM. Conservative surgery and radiation therapy for soft tissue sarcoma of the wrist, hand, ankle, and foot. Cancer. 1990;66:2482–2491.
    1. Lampert MH, Gerber LH, Glatstein E, et al. Soft tissue sarcoma: functional outcome after wide local excision and radiation therapy. Arch Phys Med Rehabil. 1984;65:477–480.
    1. O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359:2235–2241.
    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.
    1. Enneking W, ed. Modification of the system for functional evaluation in the surgical management of musculoskeletal tumours. In: Limb Salvage in Musculoskeletal Oncology. Churchill Livingstone, New York, NY, 1987.
    1. Davis WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.
    1. Ware JE. SF-36 Health Survey: Manual and Interpretation Guide. Boston: Health Institute, New England Medical Center; 1993.
    1. Wollmerstedt N, Kirschner S, Faller H, Konig A. Reliability, validity, and responsiveness of the German Short Musculoskeletal Function Assessment Questionnaire in patients undergoing surgical or conservative inpatient treatment. Qual Life Res. 2006;15:1233–1241.
    1. Swiontkowski MF, Engelberg R, Martin DP, Agel J. Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness. J Bone Joint Surg Am. 1999;81:1245–1260.
    1. Bennett PJ, Patterson C, Wearing S, Baglioni T. Development and validation of a questionnaire designed to measure foot-health status. J Am Podiatr Med Assoc. 1998;88:419–428.
    1. Landorf KB, Keenan AM. An evaluation of two foot-specific, health-related quality-of-life measuring instruments. Foot Ankle Int. 2002;23:538–546.
    1. Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol. 1984;2:187–193.
    1. Wood-Dauphinee SL, Opzoomer MA, Williams JI, et al. Assessment of global function: the Reintegration to Normal Living Index. Arch Phys Med Rehabil. 1988;69:583–590.
    1. Wood-Dauphinee S, Williams JI. Reintegration to Normal Living as a proxy to quality of life. J Chronic Dis. 1987;40:491–502.
    1. Convery FR, Minteer MA, Amiel D, Connett KL. Polyarticular disability: a functional assessment. Arch Phys Med Rehabil. 1977;58:494–499.
    1. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range, and/or interquartile range. BMC Med Res Methodol. 2014;14:135.
    1. Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27:1785–1805.
    1. Janssen SJ, Paulino Pereira NR, Raskin KA, et al. A comparison of questionnaires for assessing physical function in patients with lower extremity bone metastases. J Surg Oncol. 2016;114:691–696.
    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. 2019
    1. Chang AE, Steinberg SM, Culnane M, et al. Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas. J Clin Oncol. 1989;7:1217–1228.
    1. Mercieca-Bebber R, Palmer MJ, Brundage M, et al. Design, implementation, and reporting strategies to reduce the instance and impact of missing patient-reported outcome (PRO) data: a systematic review. BMJ Open. 2016;6:e010938.
    1. Health USDo, Human Services FDACfDE, Research, et al. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health Qual Life Outcomes. 2006;4:79.
    1. Frost MH, Reeve BB, Liepa AM, et al. What is sufficient evidence for the reliability and validity of patient-reported outcome measures? Value Health. 2007;10(Suppl 2):S94–S105.
    1. Patrick DL, Burke LB, Powers JH, et al. Patient-reported outcomes to support medical product labeling claims: FDA perspective. Value Health. 2007;10(Suppl 2):S125–S137.
    1. Calvert M, Kyte D, Mercieca-Bebber R, et al. Guidelines for inclusion of patient-reported outcomes in clinical trial protocols: the SPIRIT-PRO extension. JAMA. 2018;319:483–494.
    1. Bell RS, O’Sullivan B, Davis A, et al. Functional outcome in patients treated with surgery and irradiation for soft tissue tumours. J Surg Oncol. 1991;48:224–231.
    1. Prinsen CAC, Mokkink LB, Bouter LM, et al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27:1147–1157.
    1. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63:737–745.
    1. Han G, Bi WZ, Xu M, et al. Amputation versus limb-salvage surgery in patients with osteosarcoma: a meta-analysis. World J Surg. 2016;40:2016–2027.
    1. Mei J, Zhu XZ, Wang ZY, Cai XS. Functional outcomes and quality of life in patients with osteosarcoma treated with amputation versus limb-salvage surgery: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2014;134:1507–1516.
    1. Malek F, Somerson JS, Mitchel S, Williams RP. Does limb-salvage surgery offer patients better quality of life and functional capacity than amputation? Clin Orthop Relat Res. 2012;470:2000–2006.
    1. Ladlow P, Phillip R, Coppack R, et al. Influence of immediate and delayed lower-limb amputation compared with lower-limb salvage on functional and mental health outcomes post-rehabilitation in the UK military. J Bone Joint Surg Am. 2016;98:1996–2005.

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