[Prognostic factors of bone and soft tissue sarcoma].

The prognosis of bone and soft tissue sarcoma is influenced by factors such as pulmonary metastasis, local curability and sensitivity to chemotherapy. In cases with pulmonary lesion, the prognosis has not been favorable, but recently long-term survivors are increasing in number by effective chemotherapy, and the removal of primary and metastatic lesions. As in cases without metastatic lesions, the prognosis of high-grade sarcoma were influenced by local curability and sensitivity to chemotherapy. On the other hand, the prognosis in low grade sarcoma is mainly decided by local curability. To assure local curability the following should be considered. 1) safety surgical margin, 2) preoperative radiation therapy if the safety margin is not predicted, and 3) risk factors in local curability, which are lymph node metastasis, skip metastasis and tumor thrombus. If these risk factors are detected before operation, a more radical procedure should be planned. Moreover, cutaneous angiosarcoma and epithelioid sarcoma, which are occasionally associated with these risk factors, should be operated by ablative procedure even if the risk factors are not detected. 4) In cases with pathological fracture or inadequately operated, surgical intervention to prevent transplantation should be undertaken as soon as possible. Effective chemotherapy could improve the prognosis of high grade sarcoma. Thus, chemotherapy should be used for osteosarcoma, Ewings sarcoma, round cell sarcoma etc. However, non-effective chemotherapy might make the prognosis worse. Therefore, alternative administration of effective chemotherapeutic agents proved by clinical evaluation would be more reasonable than remaining with a certain protocol.