{
  "abstract": "Background/Objectives: Event-free survival (EFS) is widely used in soft tissue sarcoma (STS) research but combines clinically distinct outcomes such as local recurrence (LR), distant metastasis (DM), and death into a single endpoint. We aimed to decompose conventional EFS and characterize STS progression as a longitudinal process of transitions between clinically distinct disease states. Methods: Prospectively and retrospectively collected registry data from 662 patients with STS at two tertiary sarcoma centers were retrospectively analyzed. EFS was decomposed by first-event type, and longitudinal disease evolution was assessed using multi-state modeling and time-dependent Cox regression. Results: Among 585 patients included in the EFS analysis, first events were isolated LR in 114 (19.5%), DM in 106 (18.1%), synchronous LR and DM in 21 (3.6%), and death without documented recurrence in 19 (3.2%). In the full cohort, 151 deaths occurred. After multivariable adjustment, isolated LR showed a moderate but statistically imprecise association with mortality compared with the no documented LR or DM state (HR 2.55, 95% CI 0.93–7.02), whereas substantially greater mortality hazards were observed for isolated DM (HR 17.56, 95% CI 9.46–32.60) and combined LR and DM (HR 32.63, 95% CI 16.86–63.17). Conclusions: STS progression is characterized by clinically distinct, evolving disease states with markedly different prognostic implications. A disease-state framework complements conventional EFS by preserving the nature and longitudinal evolution of recurrence and may provide a more informative representation of STS progression.",
  "abstract_shown": true,
  "affiliations": [
    "Sarcoma Service, Department of Orthopedics and Trauma, Kantonsspital Winterthur, 8400 Winterthur, Switzerland",
    "Department of Hip and Knee Surgery, Schulthess Clinic Zurich, 8008 Zurich, Switzerland",
    "Department of Neuroradiology, Heidelberg University, D-69117 Heidelberg, Germany",
    "Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland",
    "Faculty of Health Sciences & Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland",
    "Sarcoma Service, Department of Radiation Oncology, Sarcoma Center, LUKS University Hospital, 6000 Lucerne, Switzerland",
    "Sarcoma Service, Department of Orthopedics and Trauma, Sarcoma Center, LUKS University Hospital, 6000 Lucerne, Switzerland"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Markus Schärer"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Philip Heesen",
      "orcid": "0000-0002-5090-4935"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Gabriela Studer",
      "orcid": "0000-0001-8780-7701"
    },
    {
      "affs": [
        6
      ],
      "name": "Bettina Vogel"
    },
    {
      "affs": [
        0,
        4,
        5,
        6
      ],
      "name": "Bruno Fuchs",
      "orcid": "0000-0001-6453-3947"
    },
    {
      "name": "on behalf of the Swiss Sarcoma Network"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/eyjfc35h0zrw4.bib",
  "cited_by": 0,
  "doi": "10.3390/cancers18213414",
  "fulltext_url": null,
  "id": "eyjfc35h0zrw4",
  "issns": [
    "2072-6694"
  ],
  "landing_url": "https://www.mdpi.com/2072-6694/18/21/3414",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Sarcoma Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7223173019",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-22",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/eyjfc35h0zrw4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:58Z",
      "native_id": "10.3390/cancers18213414",
      "source": "crossref",
      "url": "https://www.mdpi.com/2072-6694/18/21/3414"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2072-6694",
      "subfield": "oncology"
    }
  ],
  "title": "Beyond Event-Free Survival: A Multi-State Analysis of Local Recurrence, Metastasis, and Death in Soft Tissue Sarcoma",
  "title_text": "Beyond Event-Free Survival: A Multi-State Analysis of Local Recurrence, Metastasis, and Death in Soft Tissue Sarcoma",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:58Z",
  "url": "https://research.draconitic.com/paper/eyjfc35h0zrw4",
  "venue": "Cancers",
  "versions": []
}