Analysis of Prognostic Factors in 171 Patients with Myxofibrosarcoma of the Trunk and Extremities: a Cohort Study

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2021 Sep 17

PMID 34532459

Citations 3

Authors

Huanmei Liu

Xinxin Zhang

Shuguang Zhang

Shengji Yu

Affiliations

Soon will be listed here.

Abstract

Background: Myxofibrosarcoma (MFS) of the trunk and extremities has unique clinical features. However, it is not clear which indicators are the influencing factors of recurrence, metastasis, and survival of trunk and limb MFS. The aim of the present study was to analyze clinical features and prognosis of trunk and limb MFS.

Methods: The data of 171 patients with MFS of the trunk and extremities and a median follow-up period of 67 months from January 1999 to July 2018 were retrospectively analyzed. Risk factors for survival, recurrence and metastasis following resection of MFS of trunk and extremities were analyzed. The Kaplan-Meier method (log-rank test) was used for the univariate analysis and a Cox regression model was used for the multivariate analysis.

Results: The median age of the patients was 53 years; there were 111 males and 60 females. A total of 132 cases had French Federation of Cancer Centers grade 1, 24 cases had grade 2, and 15 cases had grade 3 MFS. The 3-year recurrence, 3-year metastasis, and 5-year survival rates were 29.2%, 19.3%, and 93.6%, respectively. Kaplan-Meier survival analysis showed that the surgical margin (χ=22.228, P<0.001) and tumor size (χ=6.697, P=0.010) were associated with recurrence. The surgical margin (χ=12.353, P<0.001) and CD44 expression (χ=5.227, P=0.022) were associated with metastasis. The multivariate analysis showed that the surgical margin [hazard ratio (HR) =3.635, 95% confidence interval (CI): 1.883-7.016, P<0.001] and tumor size (HR =1.889, 95% CI: 1.039-3.435, P=0.037) were risk factors for local recurrence. In addition, the surgical margin (HR =4.475, 95% CI: 1.918-10.438, P=0.001) and presence of CD44 (HR =3.406, 95% CI: 1.462-8.405, P=0.005) were risk factors for distant metastasis.

Conclusions: A negative surgical margin can be reduced effectively the rate of recurrence and metastasis in patients with MFS of the trunk and limbs. In addition, CD44 may be used to assess the metastatic risk of patients with MFS.

Citing Articles

Localized Myxofibrosarcoma: A Retrospective Analysis of Primary Therapy and Prognostic Factors in 134 Patients in a Single Institution.

Pogkas A, Reichardt P, Tunn P, Niethard M, Werner M, Ghani S Oncologist. 2023; 29(4):e544-e552.

PMID: 38141181 PMC: 10994258. DOI: 10.1093/oncolo/oyad332.

The Role of Multimodality Imaging in the Diagnosis and Follow-Up of Malignant Primary Cardiac Tumors: Myxofibrosarcoma-A Case Report and Literature Review.

Serban A, Dadarlat-Pop A, Tomoaia R, Trifan C, Molnar A, Manole S Diagnostics (Basel). 2023; 13(10).

PMID: 37238295 PMC: 10217285. DOI: 10.3390/diagnostics13101811.

Molecular and clinicopathological analysis revealed an immuno-checkpoint inhibitor as a potential therapeutic target in a subset of high-grade myxofibrosarcoma.

Yamashita A, Suehara Y, Hayashi T, Takagi T, Kubota D, Sasa K Virchows Arch. 2022; 481(4):1-17.

PMID: 35705750 DOI: 10.1007/s00428-022-03358-9.

References

Sanfilippo R, Miceli R, Grosso F, Fiore M, Puma E, Pennacchioli E . Myxofibrosarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol. 2010; 18(3):720-5. DOI: 10.1245/s10434-010-1341-4. View

Wittig B, Johansson B, Zoller M, Schwarzler C, Gunthert U . Abrogation of experimental colitis correlates with increased apoptosis in mice deficient for CD44 variant exon 7 (CD44v7). J Exp Med. 2000; 191(12):2053-64. PMC: 2193202. DOI: 10.1084/jem.191.12.2053. View

Odei B, Rwigema J, Eilber F, Eilber F, Selch M, Singh A . Predictors of Local Recurrence in Patients With Myxofibrosarcoma. Am J Clin Oncol. 2017; 41(9):827-831. DOI: 10.1097/COC.0000000000000382. View

Benz M, Czernin J, Allen-Auerbach M, Dry S, Sutthiruangwong P, Spick C . 3'-deoxy-3'-[18F]fluorothymidine positron emission tomography for response assessment in soft tissue sarcoma: a pilot study to correlate imaging findings with tissue thymidine kinase 1 and Ki-67 activity and histopathologic response. Cancer. 2011; 118(12):3135-44. PMC: 3436595. DOI: 10.1002/cncr.26630. View

Yoshimoto M, Yamada Y, Ishihara S, Kohashi K, Toda Y, Ito Y . Retroperitoneal Myxofibrosarcoma: A Controversial Entity. Pathol Res Pract. 2020; 216(6):152969. DOI: 10.1016/j.prp.2020.152969. View

Coindre J . [New WHO classification of tumours of soft tissue and bone]. Ann Pathol. 2012; 32(5 Suppl):S115-6. DOI: 10.1016/j.annpat.2012.07.006. View

Scoccianti G, Ranucci V, Frenos F, Greto D, Beltrami G, Capanna R . Soft tissue myxofibrosarcoma: A clinico-pathological analysis of a series of 75 patients with emphasis on the epithelioid variant. J Surg Oncol. 2016; 114(1):50-5. DOI: 10.1002/jso.24250. View

Muhlhofer H, Lenze U, Gersing A, Lallinger V, Burgkart R, Obermeier A . Prognostic Factors and Outcomes for Patients With Myxofibrosarcoma: A 13-Year Retrospective Evaluation. Anticancer Res. 2019; 39(6):2985-2992. DOI: 10.21873/anticanres.13430. View

Emori M, Tsukahara T, Murata K, Sugita S, Sonoda T, Kaya M . Prognostic impact of CD109 expression in myxofibrosarcoma. J Surg Oncol. 2015; 111(8):975-9. DOI: 10.1002/jso.23934. View

10.

Ghazala C, Agni N, Ragbir M, Dildey P, Lee D, Rankin K . Myxofibrosarcoma of the extremity and trunk: a multidisciplinary approach leads to good local rates of LOCAL control. Bone Joint J. 2016; 98-B(12):1682-1688. DOI: 10.1302/0301-620X.98B12.37568. View

11.

Oda Y, Takahira T, Kawaguchi K, Yamamoto H, Tamiya S, Matsuda S . Low-grade fibromyxoid sarcoma versus low-grade myxofibrosarcoma in the extremities and trunk. A comparison of clinicopathological and immunohistochemical features. Histopathology. 2004; 45(1):29-38. DOI: 10.1111/j.1365-2559.2004.01886.x. View

12.

Matuschek C, Lehnhardt M, Gerber P, Poremba C, Hamilton J, Lammering G . Increased CD44s and decreased CD44v6 RNA expression are associated with better survival in myxofibrosarcoma patients: a pilot study. Eur J Med Res. 2014; 19:6. PMC: 3942188. DOI: 10.1186/2047-783X-19-6. View

13.

Rica Tanaka , Umeyama Y, Hagiwara H, Ito-Hirano R, Fujimura S, Mizuno H . Keloid patients have higher peripheral blood endothelial progenitor cell counts and CD34 cells with normal vasculogenic and angiogenic function that overexpress vascular endothelial growth factor and interleukin-8. Int J Dermatol. 2019; 58(12):1398-1405. DOI: 10.1111/ijd.14575. View

14.

Gilg M, Sunitsch S, Leitner L, Bergovec M, Szkandera J, Leithner A . Tumor-associated mortality and prognostic factors in myxofibrosarcoma - A retrospective review of 109 patients. Orthop Traumatol Surg Res. 2020; 106(6):1059-1065. DOI: 10.1016/j.otsr.2020.04.017. View

15.

Yoshimoto M, Yamada Y, Ishihara S, Kohashi K, Toda Y, Ito Y . Comparative Study of Myxofibrosarcoma With Undifferentiated Pleomorphic Sarcoma: Histopathologic and Clinicopathologic Review. Am J Surg Pathol. 2019; 44(1):87-97. DOI: 10.1097/PAS.0000000000001389. View

16.

Tsuchie H, Emori M, Miyakoshi N, Nagasawa H, Okada K, Nanjyo H . Prognostic Impact of CD44 Expression in Patients With Myxofibrosarcoma. In Vivo. 2019; 33(6):2095-2102. PMC: 6899125. DOI: 10.21873/invivo.11709. View

17.

Kawaguchi N, Ahmed A, Matsumoto S, Manabe J, Matsushita Y . The concept of curative margin in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res. 2004; (419):165-72. DOI: 10.1097/00003086-200402000-00027. View

18.

Shipitsin M, Campbell L, Argani P, Weremowicz S, Bloushtain-Qimron N, Yao J . Molecular definition of breast tumor heterogeneity. Cancer Cell. 2007; 11(3):259-73. DOI: 10.1016/j.ccr.2007.01.013. View

19.

Solinas G, Germano G, Mantovani A, Allavena P . Tumor-associated macrophages (TAM) as major players of the cancer-related inflammation. J Leukoc Biol. 2009; 86(5):1065-73. DOI: 10.1189/jlb.0609385. View

20.

Isacke C, Yarwood H . The hyaluronan receptor, CD44. Int J Biochem Cell Biol. 2002; 34(7):718-21. DOI: 10.1016/s1357-2725(01)00166-2. View