Distal Upper Extremity Sarcoma Epidemiology: A Single-Institution Review.

BACKGROUND: Sarcoma management guidelines in the extremities have been developed based on grouped averages, which are weighted toward lower extremity sarcomas. However, sarcomas in the forearm, wrist, hand, and fingers present unique management challenges given proximity to neurovascular structures and smaller presenting size. This study aims to describe the presenting characteristics of upper extremity sarcomas evaluated at our tertiary referral hospital from 2015 to 2022. METHODS: Pathology reports from 7888 upper extremity specimens were retrospectively reviewed, yielding 119 sarcoma entries belonging to 72 patients. Operative and clinic notes, pathology reports, and radiographic images were reviewed. Baseline demographic variables (age, sex, race) and tumor-specific characteristics were collected for all 72 patients. Survival characteristics (tumor recurrence, presence of metastasis) were collected for patients with a minimum of 6 months of follow-up. RESULTS: The most common upper extremity sarcomas were undifferentiated pleomorphic sarcoma (21/72, 29%) and myxofibrosarcoma (17/72, 24%). Sixteen of 44 patients (36%) developed metastasis, and 14 of 44 patients (32%) developed local recurrence. Eight of 16 patients who developed metastases presented with tumor sizes less than 5 cm, and 9 of 14 patients who developed recurrence presented with tumor sizes less than 5 cm. Size of tumor at presentation was neither statistically associated with metastasis (P = .82) nor with recurrence (P = .28). CONCLUSIONS: Upper extremity sarcomas are a heterogeneous group of highly aggressive tumors. Current biopsy guidelines in sarcoma surveillance may not capture a majority of sarcomas in the upper extremity given the high frequency of small dimensions and indolent symptoms in even high-grade lesions.