Abstract
BackgroundThe 5-year survival rates for localized liposarcomas reportedly vary from 75% to 91% with histologic grade as the most important prognostic factor. However, it is unclear which other factors, including the initial surgery quality and recurrent tumors, influence survival in localized liposarcomas (LPS).Questions/PurposesWe analyzed factors (including AJCC staging system) influencing survival and local control of resectable LPS of the extremities/trunk wall and the impact of surgery quality and tumor status and type of disease recurrences according to pathological subtype.MethodsWe retrospectively reviewed 181 patients with localized LPS: 110 were treated for primary tumors, 50 for recurrent tumors, and 21 for wide scar resection after unplanned nonradical resection. We determined survival rates and examined factors influencing survival. The minimum followup was 4 months (median, 52 months; range, 4–168 months).ResultsFive-year disease-specific (DSS), disease-free (DFS), and local relapse-free survival (LRFS) rates were: 80%, 58%, and 75%, respectively. Five-year local relapse-free survival rates for primary versus clinically recurrent tumor versus scar after nonradical resection were: 86.1%, 52.1%, and 73.3%, respectively. The following were independent negative prognostic factors for DSS (AJCC Stage ≥ IIb), DFS (Grade 3; clinical recurrence; skin infiltration), and LRFS (clinical recurrence; R1 resection). An unplanned excision, although influencing local relapse-free survival, had no impact on disease-specific survival (calculated from date of first excision 5-year rate of 80%, considering impact of combined treatment of clinical recurrence/scar).ConclusionsWe confirmed the value of AJCC staging for predicting disease-specific survival in extremity/trunk wall LPS. Radical reresection of scar after nonradical primary tumor resection (+ radiotherapy) seems to improve disease-free and local relapse-free survival in liposarcomas. Patients with unplanned excision can be cured when referred to a sarcoma unit.Level of EvidenceLevel IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence
Highlights
Soft tissue sarcomas, a heterogeneous group of malignancies, are challenging to diagnose and treat because of their rarity, various clinical presentations, disease course, and multiple pathological subtypes
The aims of the study were to determine: (1) prognostic factors having an influence on disease-specific survival, disease-free survival, and local relapse-free survival, including the new American Joint Committee on Cancer (AJCC) staging system, based on a homogenous cohort of localized, resectable liposarcomas of the extremities/trunk wall treated with curative intent in a tertiary referral sarcoma center; (2) the impact of quality of surgery and tumor status; and (3) type of disease recurrences according to pathological subtype of liposarcoma
For local relapse-free survival we found five important factors independently related to worse prognosis: (1) clinically recurrent tumor (Fig. 2A); (2) high (Grade 2 or 3) histological grade; (3) surgical resection margins R1 (Fig. 2B); (4) unplanned excision without preoperative biopsy (Fig. 2C); and (5) myxoid/round cell or pleomorphic histologic subtype (Table 3)
Summary
A heterogeneous group of malignancies, are challenging to diagnose and treat because of their rarity, various clinical presentations, disease course, and multiple pathological subtypes. In reality, a substantial number of patients with primary soft tissue sarcomas are still treated in nonreferral centers by unplanned resection of the tumor and referred to tertiary institutions [20, 28]. Each of which included more than 100 cases, analyzed the outcomes of patients with localized liposarcomas [7, 9, 12, 17, 18] These studies suggest 5-year survival rates ranged from 75% to 91% with histologic grade as the most important prognostic factor. The 5-year survival rates for localized liposarcomas reportedly vary from 75% to 91% with histologic grade as the most important prognostic factor. This study was presented as an oral presentation during Connective Tissue Oncology Society Meeting, October 26–28, 2011, Chicago, IL, USA
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