Fungation in soft tissue sarcomas is associated with poor survival

Purpose Whilst much is known on the multiple variables associated with a poor prognosis in soft tissue sarcomas, little evidence exists on the impact of fungation at the time of presentation. The aim of this study was to assess the impact of fungation on overall and disease free survival in soft tissue sarcomas. Methods The study comprised a retrospective review of all patients presenting with a soft tissue sarcoma between 1996 and 2014 managed at a single institution. Over the 18-year study period, 2661 patients were diagnosed with a STS. Eighty-six patients (3.2%) presented with a fungating tumour. Results The five year survival for all patients with a fungating sarcoma was 15.5% (95% confidence interval: 4.6-26.4), which compared to 65.6% (95% confidence interval 63.267.8%) (p = 0.0001) for non-fungating tumours. The incidence of metastasis at presentation in the non-fungating tumour group was 11.3% of patients, compared to 20.0% in those with a fungating tumour (p = 0.0113). Factors associated with a poor prognosis in the fungating group included size, grade and tumour-type, patient age, tumour depth, and metastases at presentation. As an independent risk factor, tumour fungation was associated with a poor prognosis when compared to non-fungating tumours. The rate of limb sacrifice as primary treatment was higher in the fungating group (23% versus 73%). In spite of this, the incidence of local recurrence was higher in the fungating group (20% versus 16.5%). Conclusions Fungation is associated with a poor prognosis with a high incidence of metastases at presentation and a high rate of local recurrence. As an independent variable, fungation confers a poor prognosis when compared to non-fungation in soft tissue sarcomas.