{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:18:20Z","timestamp":1747196300056,"version":"3.40.5"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T00:00:00Z","timestamp":1662076800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Superficial soft tissue sarcomas are often left untreated unless they invade the skin and skin ulcers manifest. Progressive sarcomas frequently result in dismal oncological outcomes despite multidisciplinary treatment. This study aimed to identify prognostic factors for superficial soft tissue sarcomas.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Materials and methods<\/jats:title><jats:p>This study retrospectively analyzed the clinicopathological data of 82 patients with superficial soft tissue sarcomas treated between August 2003 and December 2020 at our institution. A superficial soft tissue sarcoma was defined if the percentage of the area occupied by the tumor in the assessed region (skin, subcutaneous) was more than 50%. Age, sex, location, tumor size, tumor-skin invasion, tumor grade, and distant metastasis at initial diagnosis were evaluated as potential prognostic factors. Cox proportional hazards regression models were used to identify the prognostic factors. Five-year survival rates were assessed by the Kaplan-Meier method.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The mean follow-up time was 60.1 months. The 5-year overall survival, 5-year local recurrence-free survival, and 5-year metastasis survival rates were 76.4%, 60.6%, and 71.0%, respectively. Univariate analysis showed significant relationships between poor prognosis and tumor size \u22655 cm, distant metastasis at initial diagnosis, and tumor-skin invasion. In the multivariate analysis, only the tumor-skin invasion was associated with worse overall survival.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Superficial soft tissue sarcomas have biologically been considered a separate category due to their better prognosis. In this study, the tumor-skin invasion was the only significant factor associated with a poor prognosis. Therefore, all superficial soft tissue sarcomas without tumor-skin invasion should be treated as early as possible.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0274077","type":"journal-article","created":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T17:37:42Z","timestamp":1662140262000},"page":"e0274077","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tumor-skin invasion is a reliable risk factor for poor prognosis in superficial soft tissue sarcomas"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8267-7389","authenticated-orcid":true,"given":"Tadashi","family":"Iwai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Hoshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoto","family":"Oebisu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Takada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshitaka","family":"Ban","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,9,2]]},"reference":[{"key":"pone.0274077.ref001","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00256-012-1385-6","article-title":"MRI of superficial soft tissue masses: analysis of features useful in distinguishing between benign and malignant lesions","volume":"41","author":"M Calleja","year":"2012","journal-title":"Skelet Radiol."},{"key":"pone.0274077.ref002","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1016\/j.ejca.2009.03.006","article-title":"Superficial soft tissue sarcomas (S-STS): a study of 367 patients from the French Sarcoma Group database","volume":"45","author":"S Salas","year":"2009","journal-title":"Eur J Cancer"},{"key":"pone.0274077.ref003","first-page":"15","article-title":"UK guidelines for the management of soft tissue sarcomas","author":"A Dangoor","year":"2016","journal-title":"Clin Sarcoma Res"},{"issue":"11","key":"pone.0274077.ref004","doi-asserted-by":"crossref","first-page":"e1553","DOI":"10.1097\/GOX.0000000000001553","article-title":"Superficial Soft-Tissue Sarcomas Rarely Require Advanced Soft-Tissue Reconstruction following Resection","volume":"5","author":"WC Eward","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"pone.0274077.ref005","article-title":"Review of primary superficial soft tissue mesenchymal tumors of malignant or intermediate biological potential","author":"DJ Oettel","year":"2022","journal-title":"Skeletal Radiol."},{"key":"pone.0274077.ref006","doi-asserted-by":"crossref","first-page":"273","DOI":"10.12968\/jowc.2009.18.7.43110","article-title":"Malignant fungating wounds: epidemiology, aetiology, presentation and assessment.","volume":"18","author":"S. Alexander","year":"2009","journal-title":"J Wound Care"},{"issue":"6","key":"pone.0274077.ref007","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.jos.2019.07.010","article-title":"Clinical course of soft tissue sarcomas presenting as malignant wounds","volume":"24","author":"M Hoshi","year":"2019","journal-title":"J Orthop Sci"},{"issue":"5","key":"pone.0274077.ref008","doi-asserted-by":"crossref","first-page":"3423","DOI":"10.1007\/s13277-014-2977-7","article-title":"Histopathological characterization of ulcerated breast cancer and comparison to their non-ulcerated counterparts","volume":"36","author":"C Staudigl","year":"2015","journal-title":"Tumour Biol"},{"issue":"1","key":"pone.0274077.ref009","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/jjco\/hyaa176","article-title":"Prognosis and surgical outcome of soft tissue sarcoma with malignant fungating wounds","volume":"51","author":"K Okajima","year":"2021","journal-title":"Jpn J Clin Oncol"},{"issue":"14","key":"pone.0274077.ref010","doi-asserted-by":"crossref","first-page":"3414","DOI":"10.3390\/cancers14143414","article-title":"Sarcoma common MHC-I haplotype restricts tumor-specific CD8+ T cell response","volume":"14","author":"L Mosca","year":"2022","journal-title":"Cancers (Basel)."},{"edition":"5","volume-title":"WHO Classification of Tumours of Soft Tissue and Bone.","year":"2020","key":"pone.0274077.ref011"},{"issue":"1","key":"pone.0274077.ref012","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/ijc.2910330108","article-title":"Soft\u2011tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system","volume":"33","author":"M Trojani","year":"1984","journal-title":"Int J Cancer"},{"key":"pone.0274077.ref013","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/978-3-319-40618-3","volume-title":"AJCC Cancer Staging Manual. Cham","author":"MB Amin","year":"2017","edition":"8"},{"key":"pone.0274077.ref014","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/00003086-200402000-00027","article-title":"The concept of curative margin in surgery for bone and soft tissue sarcoma","volume":"419","author":"N Kawaguchi","year":"2004","journal-title":"Clin Orthop Relat Res"},{"key":"pone.0274077.ref015","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1080\/01621459.1958.10501452","article-title":"Nonparametric estimation from incomplete observation","volume":"53","author":"EL Kaplan","year":"1958","journal-title":"J Am Stat Assoc"},{"key":"pone.0274077.ref016","first-page":"163","article-title":"Evaluation of survival data and two new rank order statistics arising in its consideration","volume":"50","author":"N Mantel","year":"1966","journal-title":"Cancer Chemother Rep"},{"key":"pone.0274077.ref017","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","article-title":"Regression models and life\u2011tables","volume":"34","author":"DR Cox","year":"1972","journal-title":"J R Stat Soc"},{"key":"pone.0274077.ref018","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.crad.2007.08.016","article-title":"MRI of soft-tissue masses: the relationship between lesion size, depth, and diagnosis","volume":"63","author":"A Datir","year":"2008","journal-title":"Clin Radiol"},{"key":"pone.0274077.ref019","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.jos.2017.03.017","article-title":"Statistics of soft-tissue sarcoma in Japan: Report from the Bone and Soft Tissue Tumor Registry in Japan","volume":"22","author":"K Ogura","year":"2017","journal-title":"J Orthop Sci"},{"key":"pone.0274077.ref020","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s00256-009-0855-y","article-title":"Imaging of the most frequent superficial soft tissue sarcomas","volume":"40","author":"M Morel","year":"2011","journal-title":"Skeletal Radiology"},{"key":"pone.0274077.ref021","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1007\/s00268-009-0051-1","article-title":"Superficial soft tissue sarcomas of the extremities and trunk","volume":"33","author":"A Lachenmayer","year":"2009","journal-title":"World J Surg"},{"key":"pone.0274077.ref022","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1245\/s10434-010-1034-z","article-title":"Extremity soft tissue sarcoma care in the elderly: Insights into the generalizability of NCI Cancer Trials","volume":"17","author":"WB Al\u2011Refaie","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"pone.0274077.ref023","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ejso.2013.09.004","article-title":"Favorable outcome after complete resection in elderly soft tissue sarcoma patients: Japanese Musculoskeletal Oncology Group study","volume":"40","author":"Y Yoneda","year":"2014","journal-title":"Eur J Surg Oncol"},{"issue":"3","key":"pone.0274077.ref024","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.3892\/ol.2015.3432","article-title":"Prognostic factors for elderly patients with primary malignant bone and soft tissue tumors","volume":"10","author":"T Iwai","year":"2015","journal-title":"Oncol Lett"},{"issue":"12","key":"pone.0274077.ref025","doi-asserted-by":"crossref","first-page":"e0209642","DOI":"10.1371\/journal.pone.0209642","article-title":"Diagnostic value of tumor-fascia relationship in superficial soft tissue masses on magnetic resonance imaging","volume":"13","author":"T Iwai","year":"2018","journal-title":"PLoS One"},{"issue":"2","key":"pone.0274077.ref026","doi-asserted-by":"crossref","first-page":"144","DOI":"10.6004\/jnccn.2017.7042","article-title":"The AJCC 8th Edition Staging System for Soft Tissue Sarcoma of the Extremities or Trunk: A Cohort Study of the SEER Database","volume":"16","author":"JMM Cates","year":"2018","journal-title":"J Natl Compr Canc Netw"},{"issue":"7","key":"pone.0274077.ref027","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1002\/hed.25701","article-title":"Staging soft tissue sarcoma of the head and neck: Evaluation of the AJCC 8th edition revised T classifications","volume":"41","author":"JMM Cates","year":"2019","journal-title":"Head Neck"},{"issue":"6","key":"pone.0274077.ref028","doi-asserted-by":"crossref","first-page":"2985","DOI":"10.21873\/anticanres.13430","article-title":"Prognostic Factors and Outcomes for Patients With Myxofibrosarcoma: A 13-Year Retrospective Evaluation.","volume":"39","author":"HML M\u00fchlhofer","year":"2019","journal-title":"Anticancer Res"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0274077","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T04:35:24Z","timestamp":1727930124000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0274077"}},"subtitle":[],"editor":[{"given":"Filomena","family":"de Nigris","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,9,2]]},"references-count":28,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0274077","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2022,9,2]]}}}