STS in close contact with major blood vessels is significantly associated with poor OS as well as worse MFS.

Regardless of tumor grade, particularly STS in close contact with major blood vessels should be monitored carefully during follow-up.

Recent reports show that vascular proximity on magnetic resonance imaging (MRI) increases the risk of local recurrence of thigh soft tissue sarcomas (STS). However, it remains unclear whether the defined radiological distance between the tumor and major blood vessels influences local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). We aimed to verify this association among patients with deep STS.

Clinical-pathological data of 149 patient's deep STS treated between 2014 and 2023 at a single institution were retrospectively analyzed. Based on MRI findings, the distance between the tumor and major blood vessels was investigated using two groups (“In contact” and “Not in contact”). Sex, age, tumor size, location, grade, AJCC staging, and distance to major blood vessels were evaluated using Cox proportional hazards regression models. Five-year survival rates were assessed using the Kaplan–Meier method.

Median follow-up duration was 40 (interquartile range [IQR]: 19–75) months. The five-year OS, LRFS, and MFS rates were 72.5 %, 95.5 %, and 85.2 %, respectively. Multivariate analysis revealed significant associations between poor OS and tumor stage IV as well as “In contact” with major blood vessels. Additionally, the statistical significance between distant metastasis and “In contact” with major blood vessels was clarified.

A radiological “In contact” between the tumor and major blood vessels was a significant factor associated with poor prognosis and distant metastasis. Orthopedic oncologists should consider a treatment strategy based on the relationship between the distance from the tumor to major blood vessels on MRI preoperatively.

Distance to major blood vessels

Prognosis

Deep soft tissue sarcoma

Distant metastasis

Magnetic resonance imaging

© 2025 The Authors. Published by Elsevier Ltd.