Oncological Outcomes in Patients with Appendicular Myxofibrosarcomas: A Retrospective Study

Author:

Lee Yonghoon1ORCID,Guertin Michael P.1,Summers Spencer2,Conway Sheila A.3,Al Maaieh Mothasem4,Yechieli Raphael5,Trent Jonathan5,Rosenberg Andrew E.6,Pretell-Mazzini Juan7

Affiliation:

1. Miller School of Medicine, University of Miami, Miami, FL 33136, USA

2. Orthopedic Surgery Resident, Department of Orthopedic Surgery, Jackson Memorial Hospital, Miami, FL, USA

3. Musculoskeletal Oncology Division, Department of Orthopedics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA

4. Director of Spine Tumors, University of Miami, Miami, FL 33136, USA

5. University of Miami, Jackson Memorial Hospital, Miami, FL, USA

6. Director of Anatomic Pathology, Director of Bone & Soft Tissue Pathology, Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA

7. Director of Clinical Research Musculoskeletal Oncology Division, Musculoskeletal Oncology Division, Department of Orthopedics, Miller School of Medicine, University of Miami, Miami, FL, USA

Abstract

Background. Myxofibrosarcoma (MFS) is notorious for its infiltrative growth pattern, making wide excisions difficult to achieve. Our objective was to assess the impact of surgical margins and other factors that affected rates of local recurrence (LR), distant metastasis (DM), and overall survival (OS) of individuals undergoing resection for MFS. Methods. We retrospectively reviewed the medical records of 209 patients with appendicular soft tissue sarcomas between January 2012 and June 2018. Of these, 29 patients (14%) were diagnosed with myxofibrosarcoma. These patients underwent a total of 33 resections. The pathological analyses were conducted by an experienced musculoskeletal (MSK) pathologist. Demographics data, operative details, adjuvant therapy, and oncological outcomes were assessed. Results. Of the 29 patients (33 resections), the overall LR rate was 24% (7/29) and the 2-year LR rate was 17% (5/29). Factors associated with negative oncological outcomes were as follows: tumor size ≤10 cm (2-year local recurrence-free rates (LRFRs), 65%; 95% CI, 44–86%; p = 0.02 ) and positive surgical margins grouped with surgical margins ≤0.1 cm (hazard ratio (HR), 11.74; 95% CI, 1.41–97.74; p = 0.02 ). Chemotherapy and radiotherapy together increased the 2-year LRFR (LRFR, 100%; 95% CI, 100%, p = 0.001 ). Two-year DM and OS rates were 15% and 79%, respectively. Female gender was a predictor of distant metastasis. Local recurrence had a negative impact on overall survival. Intraoperative analysis of resection margin accuracy was 75% (12/16) when non-MSK pathologists were involved but 100% accurate (12/12) when analyzed by an MSK pathologist. Conclusion. Myxofibrosarcomas showed high LR rates after treatment. Close margins (≤0.1 cm) should be considered as a risk factor for LR, and LR is associated with negative overall survival. Neoadjuvant therapy in terms of combined chemotherapy and radiation therapy associates with decreased LR rates. If intraoperative assessment of margins is to be done, it should be performed by an experienced MSK pathologist.

Publisher

Hindawi Limited

Subject

Oncology

Reference29 articles.

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2. Extremity soft tissue sarcoma in a series of patients treated at a single institution: local control directly impacts survival;A. Gronchi;Annals of Surgery,2002

3. Myxofibrosarcoma. Clinicopathologic analysis of 75 cases with emphasis on the low-grade variant;T. Mentzel;American Journal of Surgical Pathology,1996

4. Myxoid variant of malignant fibrous histiocytoma

5. MRI and histological evaluation of the infiltrative growth pattern of myxofibrosarcoma;M. Kaya;Skeletal Radiologhy,2008

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