The most important factor influencing survival in a patient with a localized soft-tissue sarcoma of the chest wall is

A.  age.

B.  complete resection.

C.  histologic type.

D.  invasion of rib.

E.  tumor size.

Answer B

Of the estimated 6,000 new cases of soft tissue sarcoma in the United States seen yearly, approximately 6%, or 360 will arise in the chest wall.  The median age of patients presenting with a chest wall soft tissue sarcoma is 38 years with a male to female ratio of 2:1.  Approximately 75% of patients have a painless mass and the remaining have a painful mass or pain alone.  Although all histologic variants of soft tissue sarcoma can present as a chest wall mass, the most common histologic types are desmoid tumor, liposarcoma, rhabomyosarcoma, fibrosarcoma, malignant peripheral nerve  tumor, and malignant fibrous histiocytoma.  The two factors which significantly impact on survival are grade of the tumor and development of metastases.  Gender, age, histology, and the extent of the local invasion are not predictors of survival.  The overall survival of patients with soft tissue sarcoma of chest wall is 66% at five years and 56% at 10 years.  The five and 10 year survivals for patients with high grade tumors are 49% and 39% respectively. The five and 10 year survivals for patients with low grade tumors are 90% and 82%, respectively.  The five and 10 year survivals of patients who develop metastases are 27% and 19%, respectively.