J Korean Orthop Assoc.  2023 Feb;58(1):18-26. 10.4055/jkoa.2023.58.1.18 .

The Impact of Delayed Diagnosis of Soft Tissue Sarcomas of the Foot and Ankle

• Kim JY
• Jang JH
• Chung SH

• KMID: 2539497
• DOI: http://doi.org/10.4055/jkoa.2023.58.1.18

Abstract

Purpose
Differential diagnosis between benign and malignant tumors is critical for appropriate treatment. Patients with soft tissue sarcomas of the foot and ankle are often diagnosed late, and it can be predicted their prognosis will be poor. This study was aimed to investigate whether the delayed diagnosis of soft tissue sarcoma of the foot and ankle affects the oncological results and prognoses.
Materials and Methods
We retrospectively reviewed the data from our tumor database and included all patients who had undergone a first wide excision of primary soft tissue sarcoma of the foot and ankle. Wide excision had been performed at a single regional musculoskeletal oncology center, and the patients had been followed up for more than 1 year. Between January 2007 to January 2021, we reviewed 26 patients with soft tissue sarcomas of the foot and ankle. Statistical analyses were performed by dividing the time of diagnosis based on 6 months, 1 year, 2 years, and 5 years or more. The primary endpoints of the study were overall, local recurrence-free, and metastasis-free survival rates. Actuarial survival was estimated using the Kaplan–Meier method and Cox regression analysis. The log-rank test was used to determine whether there was a significant difference between the survival curves according to the time of diagnosis.
Results
Six, eight, and ten patients died, had distant metastasis, and developed local recurrence during the study period, respectively. The 5-year overall survival, 5-year metastasis-free survival, and 5-year local recurrence-free survival rates of the entire patient group were 80.1%, 73.0%, and 56.7%, respectively. The 5-year overall survival rate was higher in patients diagnosed earlier when the duration until diagnosis was 1 and 5 years than in those diagnosed later. A statistically insignificant difference was observed in local recurrence and distant metastasis during each period according to the diagnostic delay.
Conclusion
Delayed diagnosis in patients with soft tissue sarcoma of the foot and ankle has no influence on the oncological prognosis. Therefore, even if the self-observation period is long in the above patients, it is necessary to actively engage in treatment.

Keyword

ankle; foot; sarcoma; soft tissue neoplasms; delayed diagnosis