Soft-Tissue Sarcoma of the Hand Is Likely to Recur, Metastasize
Key findings
- This retrospective study involved 69 adults who had a soft-tissue sarcoma of the hand treated at Massachusetts General Hospital between 1971 and 2015
- Fifty-five patients (80%) had unplanned excision of the tumor before being referred to Mass General (that is, the tumor was removed without appropriate imaging and biopsy to identify sarcoma)
- Over median follow-up of 3.8 years, nine of 66 tumors that were initially non-metastasized recurred (14%) and 15 of 66 tumors metastasized (23%)
- The five-year disease-specific mortality rate was 12% overall; it ranged from 0% for epithelioid and clear cell sarcomas to 80% for fibrosarcoma
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Most tumors in the hand are small and prove to be benign. However, epithelioid sarcoma, synovial sarcoma and clear cell sarcoma are more prevalent in the distal extremities than in other locations.
Jonathan Lans, MD, PhD, orthopaedic surgery resident, and Santiago Lozano Calderon, MD, PhD, surgeon in the Orthopaedic Oncology Service at Massachusetts General Hospital and the Mass General Cancer Center, and colleagues recently reviewed more than 40 years of records on patients treated here for a soft-tissue sarcoma of the hand. In the Journal of the American Academy of Orthopaedic Surgeons, they report patient and disease characteristics and oncologic outcomes.
Study Cohort
The researchers identified 69 adults who were treated between 1971 and 2015. The median tumor size was 4.5 cm (range, 1.4–8.6) and 44% of tumors were grade III.
The most common sarcoma subtypes were epithelioid (24%) and synovial (15%). Tumors were at the level of the metacarpals in 67% of patients, the phalanges in 26% and the wrist in 7%.
Unplanned Excision
Fifty-five patients (80%) had unplanned excision of the tumor before being referred to Mass General (that is, the tumor was removed without appropriate imaging and biopsy to identify sarcoma). Most of those patients required re-excision to achieve tumor-free margins. 39% of all 69 patients required amputation.
Outcomes
Over a median follow-up of 3.8 years:
- Recurrence—Nine of 66 tumors that were initially non-metastasized recurred (14%)
- Metastasis—15 of 66 tumors metastasized (23%); rates ranged from 15% for epithelioid sarcoma to 40% for synovial sarcoma
- Mortality—The five-year disease-specific mortality rate was 12% overall; it ranged from 0% for epithelioid and clear cell sarcomas to 80% for fibrosarcoma
What to Watch For
Early evaluation at a specialized center is vital for patients who may have soft-tissue sarcoma of the hand. Potential malignant features such as tumor size >3 cm, pain, rapid growth and subfascial location signal the need for prompt referral.
Long-term postoperative surveillance of these tumors is necessary. If the tumor has potential for lymph node metastasis, ideally follow-up should be clinical and with fluorodeoxyglucose–positron emission tomography or PET/computed tomography for 10 years.
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