Risk Factors for Local Atypical Fibroxanthoma Recurrence and Progression to Pleomorphic Dermal Sarcoma: A Meta-analysis of Individualized Participant Data

Overview

Journal J Surg Oncol

Specialties General Surgery
Oncology

Date 2022 Apr 20

PMID 35441377

Authors

Mathias Orholt

Frederik L Aaberg

Kiya Abebe

S Walsh

Randall K Roenigk

Alessandro Venzo

Grethe Schmidt

Helle Klyver

David H Jensen

Mikkel Herly

Peter V Vester-Glowinski

Affiliations

Soon will be listed here.

Abstract

Background: Risk factors for local atypical fibroxanthoma (AFX) recurrence and progression to pleomorphic dermal sarcoma (PDS) have not previously been identified.

Objective: To identify risk factors and provide follow-up suggestions for local AFX recurrence and progression to PDS.

Methods And Materials: A literature search was performed in the PubMed, EMBASE, and Cochrane databases. The PRISMA and MOOSE guidelines were followed. The risks of local AFX recurrence and progression to PDS were presented as Kaplan-Meier plots and risk factors were presented as hazard ratios (HRs) calculated with univariate and multivariate Cox regression.

Results: Five hundred and ninety-eight patients with AFX from 14 studies were included. Age >74 years and male sex significantly increased the risk of local recurrence (HR: 7.31 [95% confidence interval [CI]: 1.78-30.0], p < 0.01 and HR: 2.89 [95% CI: 1.04-8.01], p < 0.05, respectively). There was no difference when comparing wide local excision and Mohs' micrographic surgery (p = 0.89). The risks of local AFX recurrence and progression to PDS after 2 years were <1%.

Conclusion: A more intensive follow-up regimen could be considered in patients >74 years old and males due to the higher risk of local AFX recurrence.

Citing Articles

Risk of multiple primary cancers in patients with atypical fibroxanthoma/pleomorphic dermal sarcoma: A SEER analysis.

Shah V, Nijhawan R JAAD Int. 2024; 17:51-52.

PMID: 39411232 PMC: 11474184. DOI: 10.1016/j.jdin.2024.08.003.

Histopathologic Evaluation of Atypical Fibroxanthoma or Pleomorphic Dermal Sarcoma Debulk Specimen from Mohs Surgery: A Requirement for Their Proper Distinction.

Mahmood M Dermatopathology (Basel). 2024; 11(3):184-191.

PMID: 39051321 PMC: 11270197. DOI: 10.3390/dermatopathology11030019.

Mohs micrographic surgery versus wide local excision for the treatment of atypical fibroxanthoma: A retrospective cohort analysis.

Meyer S, Ren Y, Taylor S, Kiuru M, Eisen D JAAD Int. 2023; 12:174-176.

PMID: 37520753 PMC: 10371835. DOI: 10.1016/j.jdin.2023.06.003.

Atypical Fibroxanthoma: Outcomes from a Large Single Institution Series.

McClure E, Carr M, Patel A, Hussnain Naqvi S, Kim Y, Harrington M Cancer Control. 2023; 30:10732748231155699.

PMID: 36764930 PMC: 9926370. DOI: 10.1177/10732748231155699.

Risk factors for local atypical fibroxanthoma recurrence and progression to pleomorphic dermal sarcoma: A meta-analysis of individualized participant data.

Orholt M, Aaberg F, Abebe K, Walsh S, Roenigk R, Venzo A J Surg Oncol. 2022; 126(3):555-562.

PMID: 35441377 PMC: 9544245. DOI: 10.1002/jso.26898.

References

Thum C, Husain E, Mulholland K, Hornick J, Brenn T . Atypical fibroxanthoma with pseudoangiomatous features: a histological and immunohistochemical mimic of cutaneous angiosarcoma. Ann Diagn Pathol. 2013; 17(6):502-7. DOI: 10.1016/j.anndiagpath.2013.08.004. View

Seavolt M, McCall M . Atypical fibroxanthoma: review of the literature and summary of 13 patients treated with mohs micrographic surgery. Dermatol Surg. 2006; 32(3):435-41. DOI: 10.1111/j.1524-4725.2006.32087.x. View

Wylie J, Hampton N, Telfer M, Clarke A . Atypical fibroxanthoma: Case series of 16 patients. Br J Oral Maxillofac Surg. 2010; 48(6):466-8. DOI: 10.1016/j.bjoms.2009.08.040. View

Kempson R, McGavran M . ATYPICAL FIBROXANTHOMAS OF THE SKIN. Cancer. 1964; 17:1463-71. DOI: 10.1002/1097-0142(196411)17:11<1463::aid-cncr2820171114>3.0.co;2-e. View

Tolkachjov S, Brodland D, Coldiron B, Fazio M, Hruza G, Roenigk R . Understanding Mohs Micrographic Surgery: A Review and Practical Guide for the Nondermatologist. Mayo Clin Proc. 2017; 92(8):1261-1271. DOI: 10.1016/j.mayocp.2017.04.009. View

Iglesias-Pena N, Lopez-Solache L, Martinez-Campayo N, Meilan-Sanchez I, Yebra-Pimentel M, Balboa-Barreiro V . Incidence rate and clinicopathological features of 62 atypical fibroxanthomas in a North-Western Spanish population. Australas J Dermatol. 2019; 61(1):e22-e27. DOI: 10.1111/ajd.13102. View

Hanlon A, Stasko T, Christiansen D, Cyrus N, Galan A . LN2, CD10, and Ezrin Do Not Distinguish Between Atypical Fibroxanthoma and Undifferentiated Pleomorphic Sarcoma or Predict Clinical Outcome. Dermatol Surg. 2017; 43(3):431-436. DOI: 10.1097/DSS.0000000000001000. View

Tolkachjov S, Kelley B, Alahdab F, Erwin P, Brewer J . Atypical fibroxanthoma: Systematic review and meta-analysis of treatment with Mohs micrographic surgery or excision. J Am Acad Dermatol. 2018; 79(5):929-934.e6. DOI: 10.1016/j.jaad.2018.06.048. View

Limmer B, Clark D . Cutaneous micrographic surgery for atypical fibroxanthoma. Dermatol Surg. 1997; 23(7):553-7; discussion 557-8. DOI: 10.1111/j.1524-4725.1997.tb00685.x. View

10.

Stroup D, Berlin J, Morton S, Olkin I, Williamson G, Rennie D . Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000; 283(15):2008-12. DOI: 10.1001/jama.283.15.2008. View

11.

Wang W, Torres-Cabala C, Curry J, Ivan D, McLemore M, Tetzlaff M . Metastatic atypical fibroxanthoma: a series of 11 cases including with minimal and no subcutaneous involvement. Am J Dermatopathol. 2015; 37(6):455-61. DOI: 10.1097/DAD.0000000000000237. View

12.

Soleymani T, Hollmig S . Conception and Management of a Poorly Understood Spectrum of Dermatologic Neoplasms: Atypical Fibroxanthoma, Pleomorphic Dermal Sarcoma, and Undifferentiated Pleomorphic Sarcoma. Curr Treat Options Oncol. 2017; 18(8):50. DOI: 10.1007/s11864-017-0489-6. View

13.

Koch M, Freundl A, Agaimy A, Kiesewetter F, Kunzel J, Cicha I . Atypical Fibroxanthoma - Histological Diagnosis, Immunohistochemical Markers and Concepts of Therapy. Anticancer Res. 2015; 35(11):5717-35. View

14.

Orholt M, Aaberg F, Abebe K, Walsh S, Roenigk R, Venzo A . Risk factors for local atypical fibroxanthoma recurrence and progression to pleomorphic dermal sarcoma: A meta-analysis of individualized participant data. J Surg Oncol. 2022; 126(3):555-562. PMC: 9544245. DOI: 10.1002/jso.26898. View

15.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J . Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73(9):712-6. DOI: 10.1046/j.1445-2197.2003.02748.x. View

16.

Phan K, Onggo J . Time to recurrence after surgical excision of atypical fibroxanthoma-updated systematic review and meta-analysis. Australas J Dermatol. 2019; 60(3):e220-e222. DOI: 10.1111/ajd.13010. View

17.

Ziemer M . Atypical fibroxanthoma. J Dtsch Dermatol Ges. 2012; 10(8):537-50. DOI: 10.1111/j.1610-0387.2012.07980.x. View

18.

Davidson J, Demsey D . Atypical fibroxanthoma: clinicopathologic determinants for recurrence and implications for surgical management. J Surg Oncol. 2011; 105(6):559-62. DOI: 10.1002/jso.22128. View

19.

Wollina U, Schonlebe J, Ziemer M, Friedling F, Koch A, Haroske G . Atypical fibroxanthoma: a series of 56 tumors and an unexplained uneven distribution of cases in southeast Germany. Head Neck. 2014; 37(6):829-34. DOI: 10.1002/hed.23673. View

20.

Hudson A, Winkelmann R . Atypical fibroxanthoma of the skin: a reappraisal of 19 cases in which the original diagnosis was spindle-cell squamous carcinoma. Cancer. 1972; 29(2):413-22. DOI: 10.1002/1097-0142(197202)29:2<413::aid-cncr2820290224>3.0.co;2-0. View