{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T22:43:48Z","timestamp":1790549028903,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T00:00:00Z","timestamp":1727481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The impact of surgical resection versus non-resection on cancer-specific mortality (CSM) in soft tissue pelvic sarcoma remains largely unclear, particularly when considering histologic subtypes such as liposarcoma, leiomyosarcoma, and sarcoma NOS. The objective of the present study was to first report data regarding the association between surgical resection status and CSM in soft tissue pelvic sarcoma. Methods: Using data from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2019, we identified 2491 patients diagnosed with pelvic soft tissue sarcoma. Cumulative incidence plots were used to illustrate CSM and other-cause mortality rates based on the histologic subtype and surgical resection status. Competing risk regression models were employed to assess whether surgical resection was an independent predictor of CSM in both non-metastatic and metastatic patients. Results: Among the 2491 patients with soft tissue pelvic sarcoma, liposarcoma was the most common subtype (41%), followed by leiomyosarcoma (39%) and sarcoma NOS (20%). Surgical resection rates were 92% for liposarcoma, 91% for leiomyosarcoma, and 58% for sarcoma NOS in non-metastatic patients, while for metastatic patients, the rates were 55%, 49%, and 23%, respectively. In non-metastatic patients who underwent surgical resection, five-year CSM rates by histologic subtype were 10% for liposarcoma, 32% for leiomyosarcoma, and 27% for sarcoma NOS. The multivariable competing risk regression analysis showed that surgical resection provided a protective effect across all histologic subtypes in non-metastatic patients (liposarcoma HR: 0.2, leiomyosarcoma HR: 0.5, sarcoma NOS HR: 0.4). In metastatic patients, surgical resection had a protective effect for those with leiomyosarcoma (HR: 0.6) but not for those with sarcoma NOS. An analysis for metastatic liposarcoma was not possible due to insufficient data. Conclusions: In non-metastatic soft tissue pelvic sarcoma, surgical resection may be linked to a reduction in CSM. However, in metastatic patients, this protective effect appears to be limited primarily to those with leiomyosarcoma.<\/jats:p>","DOI":"10.3390\/jcm13195787","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T06:39:35Z","timestamp":1727678375000},"page":"5787","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Effect of Surgical Resection on Cancer-Specific Mortality in Pelvic Soft Tissue Sarcoma According to Histologic Subtype and Stage"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0337-3331","authenticated-orcid":false,"given":"Mattia Luca","family":"Piccinelli","sequence":"first","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"},{"name":"Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy"},{"name":"School of Urology, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Baudo","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"},{"name":"School of Urology, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"},{"name":"Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Tappero","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"},{"name":"Department of Urology, IRCCS Policlinico San Martino, 16132 Genova, Italy"},{"name":"Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4829-0241","authenticated-orcid":false,"given":"Cristina","family":"Cano Garcia","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"},{"name":"Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Barletta","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"},{"name":"Division of Experimental Oncology, Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reha-Baris","family":"Incesu","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"},{"name":"Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5340-8569","authenticated-orcid":false,"given":"Simone","family":"Morra","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"},{"name":"Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Scheipner","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"},{"name":"Department of Urology, Medical University of Graz, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Tian","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9373-1413","authenticated-orcid":false,"given":"Stefano","family":"Luzzago","sequence":"additional","affiliation":[{"name":"Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy"},{"name":"Department of Oncology and Haemato-Oncology, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Alessandro","family":"Mistretta","sequence":"additional","affiliation":[{"name":"Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy"},{"name":"Department of Oncology and Haemato-Oncology, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9250-7858","authenticated-orcid":false,"given":"Matteo","family":"Ferro","sequence":"additional","affiliation":[{"name":"Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2986-5617","authenticated-orcid":false,"given":"Fred","family":"Saad","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahrokh F.","family":"Shariat","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA"},{"name":"Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"},{"name":"Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Ahyai","sequence":"additional","affiliation":[{"name":"Department of Urology, Medical University of Graz, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7033-1380","authenticated-orcid":false,"given":"Derya","family":"Tilki","sequence":"additional","affiliation":[{"name":"Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany"},{"name":"Department of Urology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany"},{"name":"Department of Urology, Koc University Hospital, 34010 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Briganti","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology, Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix K. H.","family":"Chun","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2492-7279","authenticated-orcid":false,"given":"Carlo","family":"Terrone","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS Policlinico San Martino, 16132 Genova, Italy"},{"name":"Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Carmignani","sequence":"additional","affiliation":[{"name":"School of Urology, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"},{"name":"Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy"},{"name":"Department of Urology, IRCCS Ospedale Galeazzi\u2014Sant\u2019Ambrogio, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ottavio","family":"de Cobelli","sequence":"additional","affiliation":[{"name":"Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy"},{"name":"Department of Oncology and Haemato-Oncology, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Musi","sequence":"additional","affiliation":[{"name":"Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy"},{"name":"Department of Oncology and Haemato-Oncology, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre I.","family":"Karakiewicz","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr\u00e9al Health Center, Montreal, QC H2X 3E4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.ejca.2012.09.011","article-title":"Descriptive Epidemiology of Sarcomas in Europe: Report from the RARECARE Project","volume":"49","author":"Stiller","year":"2013","journal-title":"Eur. J. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1016\/j.ejso.2022.09.011","article-title":"Management of Pelvic Sarcoma","volume":"48","author":"Lee","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.suc.2016.05.005","article-title":"Epidemiology and Etiology of Sarcomas","volume":"96","author":"Hui","year":"2016","journal-title":"Surg. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1056\/NEJMra041866","article-title":"Soft-Tissue Sarcomas in Adults","volume":"353","author":"Clark","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.ejso.2022.06.003","article-title":"Pelvic Soft Tissue Sarcomas","volume":"49","author":"Dumitra","year":"2023","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/jso.1055","article-title":"Soft Tissue Sarcomas Involving the Pelvis","volume":"77","author":"Lewis","year":"2001","journal-title":"J. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/13577140410001679211","article-title":"Adult Pelvic Sarcomas: A Heterogeneous Collection of Sarcomas?","volume":"8","author":"Houtkamp","year":"2004","journal-title":"Sarcoma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1148\/rg.2017160157","article-title":"Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 1\u2014Common Sarcomas","volume":"37","author":"Levy","year":"2017","journal-title":"Radiographics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.jss.2022.10.026","article-title":"Resection of Recurrent Pelvic Soft Tissue Sarcoma: Is the Risk Worth the Reward?","volume":"283","author":"Mor","year":"2023","journal-title":"J. Surg. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101814","DOI":"10.1016\/j.suronc.2022.101814","article-title":"Treatment for Local Control of Retroperitoneal and Pelvis Sarcomas: A Review of the Literature","volume":"43","author":"Rust","year":"2022","journal-title":"Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/jso.24934","article-title":"The Role and Outcomes of Palliative Surgery for Retroperitoneal Sarcoma","volume":"117","author":"Zerhouni","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.ejso.2022.12.005","article-title":"Oncologic Outcomes of Surgically Managed Primary Pelvic Soft Tissue Sarcoma; Tumour Biology or Surgical Constraints of the True Pelvis?","volume":"49","author":"Khan","year":"2023","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/iju.14417","article-title":"Adult Genitourinary Sarcoma: The Era of Optional Chemotherapeutic Agents for Soft Tissue Sarcoma","volume":"28","author":"Urasaki","year":"2021","journal-title":"Int. J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1097\/SLA.0000000000000869","article-title":"Lessons Learned from the Study of 10,000 Patients with Soft Tissue Sarcoma","volume":"260","author":"Brennan","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1097\/01.sla.0000086542.11899.38","article-title":"Histologic Subtype and Margin of Resection Predict Pattern of Recurrence and Survival for Retroperitoneal Liposarcoma","volume":"238","author":"Singer","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S479","DOI":"10.1016\/j.jcot.2020.04.013","article-title":"Epidemiology and Survival of Liposarcoma and Its Subtypes: A Dual Database Analysis","volume":"11","author":"Amer","year":"2020","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1245\/s10434-013-2876-y","article-title":"Predictors of Survival and Recurrence in Primary Leiomyosarcoma","volume":"20","author":"Gladdy","year":"2013","journal-title":"Ann. Surg. Oncol."},{"key":"ref_18","first-page":"6","article-title":"Primary Bladder Sarcoma: A Multi-Institutional Experience from the Rare Cancer Network","volume":"95","author":"Bettoli","year":"2023","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151743","DOI":"10.1016\/j.anndiagpath.2021.151743","article-title":"Leiomyosarcoma of the Urinary Bladder: A SEER Database Study and Comparison to Leiomyosarcomas of the Uterus and Extremities\/Trunk","volume":"53","author":"Coiner","year":"2021","journal-title":"Ann. Diagn. Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6852","DOI":"10.1245\/s10434-020-09576-2","article-title":"Risk Assessment of Visceral Sarcomas: A Comparative Study of 2698 Cases from the SEER Database","volume":"28","author":"Dashti","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_21","first-page":"334","article-title":"Adult Genitourinary Sarcoma: A Population-Based Analysis of Clinical Characteristics and Survival","volume":"38","author":"Nazemi","year":"2020","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"70","DOI":"10.32074\/1591-951X-213","article-title":"The 2020 WHO Classification of Soft Tissue Tumours: News and Perspectives","volume":"113","author":"Sbaraglia","year":"2021","journal-title":"Pathologica"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.euo.2018.05.008","article-title":"Surgically Treated Retroperitoneal Sarcoma: A Population-Based Competing Risks Analysis","volume":"1","author":"Nazzani","year":"2018","journal-title":"Eur. Urol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1245\/ASO.2004.09.005","article-title":"Evaluation of a Clinically Applicable Post-Surgical Classification System for Primary Retroperitoneal Soft-Tissue Sarcoma","volume":"11","author":"Hennipman","year":"2004","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1038\/bmt.2009.359","article-title":"Regression Modeling of Competing Risk Using R: An in Depth Guide for Clinicians","volume":"45","author":"Scrucca","year":"2010","journal-title":"Bone Marrow Transpl."},{"key":"ref_26","unstructured":"Wilson, A., and Norden, N. (2024, September 22). The R Project for Statistical Computing the R Project for Statistical Computing. Available online: https:\/\/www.r-project.org\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102074","DOI":"10.1016\/j.suronc.2024.102074","article-title":"Surgically Treated Pelvic Liposarcoma and Leiomyosarcoma: The Effect of Tumor Size on Cancer-Specific Survival","volume":"54","author":"Baudo","year":"2024","journal-title":"Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.suc.2022.04.004","article-title":"Retroperitoneal Sarcomas: Histology Is Everything","volume":"102","author":"Turgeon","year":"2022","journal-title":"Surg. Clin. N. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1111\/ans.17275","article-title":"Survival and Morbidity Outcomes after Pelvic Exenteration for Pelvic Sarcoma: An Institutional Series","volume":"92","author":"Lee","year":"2022","journal-title":"ANZ J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1002\/jso.27271","article-title":"Surgical Site Infection after Pelvic Bone and Soft Tissue Sarcoma Resection: Risk Factors, Microbiology, and Impact of Extended Postoperative Antibiotic Prophylaxis","volume":"128","author":"Bensaid","year":"2023","journal-title":"J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1002\/jso.27290","article-title":"Risk Factors for 30-Day Soft Tissue Complications after Pelvic Sarcoma Surgery: A National Surgical Quality Improvement Program Study","volume":"128","author":"Gonzalez","year":"2023","journal-title":"J. Surg. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/19\/5787\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:05:42Z","timestamp":1760112342000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/19\/5787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,28]]},"references-count":31,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["jcm13195787"],"URL":"https:\/\/doi.org\/10.3390\/jcm13195787","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,28]]}}}