To determine if rates of local recurrence and metastasis differ in upper versus lower extremity sarcomas. Prospectively collected data relating to patients undergoing limb-sparing surgery for extremity soft tissue sarcoma between January 1986 and April 1997 were analysed. Local recurrence-free and metastasis-free rates were calculated using the method of Kaplan and Meier. Univariate and multivariate analyses of potential predictive factors were evaluated with the log-rank test and the Cox proportional hazards model. Of 480 eligible patients, 48 (10. 0%) had a local recurrence and 131 (27. 3%) developed metastases. Median follow-up of survivors was 4. 8 years (0. 1 to 12. 9). There were 139 upper and 341 lower extremity tumours. Upper extremity tumours were more often treated by unplanned excision before referral (89 vs 160, p<
0. 001) and were smaller (6. 0cm vs 9. 3cm, p<
0. 000). Lower extremity tumours were more often deep to or involving the investing fascia (280 vs. 97, p<
0. 003). The distribution of histological types differed in each extremity. Fewer upper extremity tumours were treated with adjuvant radiotherapy (98 vs. 289, p<
0. 000). The 5-year local recurrence-free rate was 82% in the upper and 93% in the lower extremity (p<
0. 002). Local recurrence was predicted by surgical margin status (hazard ratio 3. 16, p<
0. 000) but not extremity (p=0. 127) or unplanned excision before referral (p=0. 868). The 5-year metastasis-free rate was 82% in the upper and 69% in the lower extremity (p<
0. 013). Metastasis was predicted by high histological grade (hazard ratio 17. 28, p<
0. 000), tumour size in cm (hazard ratio 1. 05, p<
0. 001) and deep location (hazard ratio 1. 93, p<
0. 028) but not by extremity (p=0. 211). Local recurrence is more frequent after treatment for upper compared with lower extremity sarcomas. Variation in the use of radiotherapy and differences in histological type may be contributory. Metastasis is more frequent after treatment for lower extremity sarcomas because tumours tend to be large and deep.
The aim of this study was to compare implementation of RCGP guidelines in patients in Primary Care with acute low back pain between GP and Nurse Practitioner. This report presents preliminary results. The intention was to recruit 200 patients presenting to GP with new episode of back pain. 50% randomised to NP care, 50% to GP care. Outcome measured by documentation audit and patient feedback. Individuals complete a questionnaire which includes a Low Back Outcome Score (LBOS) at 14 weeks, 6,12 and 24 months. All patients in NP arm given back book and advised against bed rest.
Initial results suggest no significant difference in outcome between GP and Nurse Practitioner patients. Of interest is that 10% and 13% of patients failed to recall important features of management. This implies that audit of healthcare processes by patient questionnaire may be unsatisfactory.