Introduction
Patients and Methods
Factors | Number of patients | Percent |
---|---|---|
Age (years) | ||
0–49 | 69 | 38 |
> 49–59 | 47 | 26 |
> 59–89 | 65 | 36 |
Sex | ||
Female | 88 | 49 |
Male | 93 | 51 |
Primary tumor location | ||
Lower extremity | 138 | 76 |
Upper extremity | 18 | 10 |
Trunk | 25 | 14 |
Histological grade | ||
1 | 64 | 35 |
2 | 51 | 28 |
3 | 66 | 37 |
Tumor size (cm) | ||
0–5 | 26 | 14 |
> 5–50 | 155 | 86 |
Tumor status at the beginning of treatment in sarcoma center | ||
Primary tumor | 110 | 61 |
Clinical recurrence | 50 | 27.5 |
Scar after primary nonradical resection | 21 | 11.5 |
Tumor biopsy before primary surgery | ||
No | 73 | 40 |
Yes | 108 | 60 |
Surgical resection margins | ||
R0 | 148 | 82 |
R1 | 33 | 18 |
Histological subtype | ||
Myxoid/round-cell | 104 | 57 |
Pleomorphic | 49 | 28 |
Well-differentiated | 27 | 15 |
Skin infiltration | ||
No | 170 | 94 |
Yes | 11 | 6 |
AJCC stage | ||
Ia | 14 | 7.5 |
Ib | 50 | 27.5 |
IIa | 10 | 5.5 |
IIb | 48 | 27 |
III | 58 | 32 |
Adjuvant radiotherapy | ||
No | 29 | 16 |
Yes | 152 | 84 |
Initial level of hemoglobin | ||
Decreased | 16 | 9 |
Normal | 165 | 91 |
Factor | 5-year survival | 95% confidence interval | p value |
---|---|---|---|
Age (years) | |||
0–49 | 79.7% | 69.3%–91.6% | 0.81 |
49–59 | 80.6% | 68.4%–94.8% | |
59–89 | 78.1% | 65.7%–92.9% | |
Sex | |||
Female | 86.2% | 78.0%–95.2% | 0.05 |
Male | 71.7% | 60.8%–84.6% | |
Primary tumor site | |||
Extremity | 78.3% | 70.7%–86.8% | 0.96 |
Trunk wall | 83.0% | 66.5%–100.0% | |
Primary tumor site (extremities only) | |||
Lower extremity | 77.2% | 69.2%–86.0% | 0.19 |
Upper extremity | 100.0% | – | |
Histological grade | |||
1 | 94.6% | 88.9%–100.0% | < 0.0001 |
2 | 83.6% | 72.0%–97.0% | |
3 | 57.5% | 43.8%–75.4% | |
Tumor size (cm) | |||
0–5 | 100.0% | – | 0.04 |
> 5–50 | 75.8% | 67.5%–85.2% | |
Tumor status at beginning of therapy in tertiary center | |||
Primary tumor | 79.4% | 70.5%–89.3% | 0.04 |
Clinical recurrence | 71.1% | 57.7%–87.6% | |
Scar after nonradical surgery | 100.0% | – | |
Biopsy before primary surgery | |||
No | 77.8% | 67.3%–90.0% | 0.62 |
Yes | 81.0% | 72.5%–90.5% | |
Radical surgery margins status | |||
R0 | 80.5% | 72.2%–88.6% | 0.58 |
R1 | 77.5% | 63.0%–95.3% | |
Histological subtype | |||
Myxoid/round cell | 78.2% | 68.6%–89.1% | 0.04 |
Pleomorphic | 67.5% | 52.5%–86.8% | |
Well-differentiated | 95.7% | 87.7%–100.0% | |
Skin infiltration/ulceration | |||
No | 80.6% | 72.4%–87.6% | 0.29 |
Yes | 62.3% | 35.5%–100.0% | |
AJCC staging groups | |||
Ia | 100.0% | – | < 0.0001 |
Ib | 93.4% | 86.4%–100.0% | |
IIa | 100.0% | – | |
IIb | 77.5% | 64.6%–93.0% | |
III | 58.5% | 44.2%–77.3% | |
Initial level of hemoglobin | |||
Decreased | 76.6% | 55.6%–100.0% | 0.85 |
Normal | 79.1% | 71.5%–87.4% |
Factor | 5-year survival | 95% confidence interval | p value |
---|---|---|---|
Age (years) | |||
0–49 | 71.7% | 60.0%–85.7% | 0.18 |
49–59 | 84.9% | 73.3%–98.3% | |
59–89 | 65.6% | 48.7%–88.2% | |
Sex | |||
Female | 78.4% | 68.4%–89.9% | 0.29 |
Male | 68.6% | 56.0%–84.2% | |
Primary tumor site | |||
Extremity | 75.7% | 67.1%–85.5% | 0.10 |
Trunk wall | 59.6% | 39.7%–89.5% | |
Primary tumor site (extremities only) | |||
Lower extremity | 75.3% | 66.2%–85.6% | 0.59 |
Upper extremity | 85.9% | 69.5%–100.0% | |
Histological grade | |||
1 | 87.6% | 78.7%–97.5% | 0.04 |
2 | 69.0% | 54.6%–87.2% | |
3 | 60.1% | 44.3%–81.5% | |
Tumor size (cm) | |||
0–5 | 84.6% | 67.1%–100.0% | 0.19 |
5–50 | 71.3% | 61.8%–82.2% | |
Tumor status at beginning of therapy in tertiary center | |||
Primary tumor | 86.1% | 78.5%–94.5% | 0.01 |
Clinical recurrence | 52.1% | 36.6%–74.3% | |
Scar after nonradical surgery | 73.3% | 53.6%–100.0% | |
Biopsy before primary surgery | |||
No | 58.1% | 45.7%–74.0% | < 0.0001 |
Yes | 86.1% | 77.0%–96.3% | |
Radical surgery margins status | |||
R0 | 77.5% | 68.7%–87.4% | 0.01 |
R1 | 60.9% | 44.8%–82.6% | |
Histological subtype | |||
Myxoid/round cell | 72.5% | 60.9%–86.3% | 0.03 |
Pleomorphic | 55.0% | 38.2%–79.1% | |
Well-differentiated | 95.2% | 86.6%–100.0% | |
Skin infiltration/ulceration | |||
No | 76.2% | 65.8%–83.8% | 0.13 |
Yes | 64.3% | 40.9%–100.0% | |
AJCC staging groups | |||
Ia | 85.7% | 63.3%–100.0% | 0.10 |
Ib | 87.9% | 78.5%–98.5% | |
IIa | 80.0% | 51.6%–100.0% | |
IIb | 67.0% | 52.1%–86.3% | |
III | 59.8% | 43.3%–82.7% | |
Initial level of hemoglobin | |||
Decreased | 76.1% | 56.6%–99.7% | 0.76 |
Normal | 72.6% | 63.5%–82.9% |
Results
Factor | Hazard ratio | 95% CI | p value | |
---|---|---|---|---|
DSS | ||||
Primary tumor | ||||
Clinical recurrence | 1.124 | 0.540 | 2.340 | 0.760 |
Scar after nonradical surgery | 0.160 | 0.021 | 1.229 | 0.078 |
AJCC stage | ||||
2 | 2.117 | 0.706 | 6.345 | 0.180 |
3 | 5.772 | 2.075 | 16.057 | 0.001 |
DFS | ||||
Grade | ||||
2 versus 1 | 1.543 | 0.742 | 3.212 | 0.250 |
3 versus 1 | 3.808 | 1.925 | 7.531 | 0.000 |
Primary tumor | ||||
Clinical recurrence | 2.219 | 1.317 | 3.737 | 0.003 |
Scar after nonradical surgery | 0.884 | 0.336 | 2.324 | 0.800 |
Skin infiltration | ||||
Yes versus no | 2.795 | 1.380 | 5.661 | 0.004 |
LRFS | ||||
Primary tumor | ||||
Clinical recurrence | 2.835 | 1.389 | 5.786 | 0.004 |
Scar after nonradical surgery | 1.436 | 0.458 | 4.503 | 0.530 |
R0/R1 margins | ||||
R1 versus R0 | 2.090 | 1.014 | 4.307 | 0.046 |
Liposarcoma subtype (number) | Local relapse [number (%)] | Distant metastases | ||||
---|---|---|---|---|---|---|
Lungs [number (%)] | Trunk wall [number (%)] | Abdominal cavity [number (%)] | Nodal metastases [number (%)] | Liver [number (%)] | ||
Well differentiated (27) | 4 (14.8) | 0 | 0 | 0 | 0 | 0 |
Myxoid/round cell (104) | 24 (23.1) | 10 (9.6) | 5 (4.8) | 4 (3.8) | 2 (2) | 0 |
Pleomorphic (49) | 7 (14.3) | 13 (26.5) | 1 (2) | 1 (2) | 1 (2) | 2 (4) |
Discussion
Series | Number of patients and followup time | Median age (years) | Site (%) | Subtypes | Primary/recurrent tumors | DSS/OS | LR | Prognostic factors for survival |
---|---|---|---|---|---|---|---|---|
Current study | 181, median followup 52 months (minimum, 4 months) | 58 | Upper extremity (10%), lower extremity (76%), trunk (14%) | Well-differentiated, myxoid/round cell, pleomorphic | 61% primary | DSS 5-year: 80% | 19.3% Factors related to LRs: status at presentation, clinically recurrent tumor, high histological grade, microscopically positive surgical resection margin, unplanned excision without preoperative biopsy and nonwell-differentiated histological subtype | Negative factor for DSS (multivariate analysis): AJCC Stage 3 |
Moore Dala et al. [17] | 801, median followup 45 months (all), 51 months (survivors); (minimum, 1 month) | 56 | All Upper extremity (7.9%), lower extremity (48.6%), retroperitoneum (33.5%), trunk (10.6%) | All | Primary only | DSS 5-year: 83%, 12-year: 72% | Not reported | Important factors for DSS (multivariate analysis): age, presentation status, primary site, histological variant, tumor burden, and gross margin status |
Moreau et al. [18] | 418, median followup 5.2 years (minimum, 0.1 year) | 45 | Upper extremity: 7%, lower extremity: 90%, trunk wall: 2% | Myxoid/round cell | 112 (27%) after unplanned excision | DSS 5-year: 91% (pure myxoid) and 79% (round cell) | 7.4%; positive microscopic margin strongly related to LRs; radiotherapy reduced LRs | Negative for DSS multivariate analysis): age at diagnosis > 45 years, tumor diameter > 10 cm, round cell percentage > 5% |
Fiore et al. [9] | 329, median followup 119 months (minimum, not available) | 49 | All Head/neck: 1%, trunk: 5%; retroperitoneum: 12%, extremities: 83% | Pleomorphic (P) and myxoid/round cell (M/R) | 214 primary/ 115 recurrent | DSS 5-year: 83%; 10-year: 75%; Primary tumor: 5-year: 90%; recurrent tumors: 5-year: 72% | 25%; multivariate negative factors for LR-free survival: recurrent tumor, non-extremity tumor site and lack of adjuvant radiotherapy | Negative for DSS (multivariate): recurrent tumors, size > 10 cm, positive surgical margins, higher tumor grade (if instead of histology) |
Engström et al. [7] | 319 (237 localized), median followup 8 years (survivors; minimum, 0 years) | 54 | Upper extremity: 8%, lower extremity: 84%, trunk: 8% | All | 75% primary | OS/DSS 10-year: 64%/84% | 13%; Negative factors for LR-free: surgery outside sarcoma center and histological type dedifferentiated liposarcoma; radiotherapy reduced LRs | Adverse factors for MFS: old age, large tumor size, high grade, nonwide surgical margin at reresection and histological type |
Haniball et al. [12] | 160, median followup 4.6 years (minimum, 2 years) | 48.6 | Upper extremity: 8%, lower extremity: 92%, | Myxoid/round cell | primary | DSS 5-year: 75%, 10-year: 56% | 12% | Negative for DSS (multivariate analysis): presence of round cell component > 5% |
Zagars et al. [33] | 112, median followup 9.1 years (minimum, 2 years) | 48 | All (68% lower extremity) | All | 83% primary/17% recurrent | OS 5-year: 79%, 10-year: 69% | 13%; with LRs correlated pleomorphic histology, positive resection margins and prior disease recurrence | Negative for OS: age > 48 years, tumor size > 5 cm, pleomorphic histology |
Nishida et al. [22] | 53, mean followup 60 months (minimum, 12 months) | 51 | Upper extremity: 13.2%, lower extremity: 62.3%, trunk: 24.5% | Myxoid only | Not reported | OS 5-year: 90%, 10-year: 83% | 13% | Negative for OS: age > 60 years |
ten Heuvel et al. [31] | 49, median followup 101 months (minimum, 4 months) | 44 | All (84% lower extremity) | Myxoid/round cell | Not reported | DSS: 5-year: 85%, 10-year: 72% | 33% | Negative for DSS: older age at presentation, higher tumor grade and larger tumor size |