Evaluation of prognostic factors in localized high-grade undifferentiated pleomorphic sarcoma: report of a multi-institutional experience of Anatolian Society of Medical Oncology

Abstract

Most data on prognostic factors for patients with high-grade undifferentiated pleomorphic sarcoma (HGUPS) is obtained from analyses of soft tissue sarcomas. The purpose of this study was to evaluate the clinicopathologic features and their impact on outcomes specifically in patients diagnosed with HGUPS. In this multicenter trial, we retrospectively analyzed 112 patients who were diagnosed and treated at 12 different institutions in Turkey. We collected data concerning the patients, tumor characteristics, and treatment modalities. There were 69 males (61.6 %) and 43 females (38.4 %). Median age was 56 years (19-90). The most common anatomic site of tumor origin was the upper extremity. Pleomorphic variant was the predominant histological subtype. Median tumor size was 8.2 cm (0.6-30 cm). Tumors were mainly deeply seated (57.1 %). Fifty-seven patients (50.9 %) were stage II and the remainder were stage III at the time of diagnosis. Median follow-up was 30 months (2-160). The primary site of distant metastasis was the lung (73.5 %) and the second most common site was the liver (11.7 %). The 5-year overall survival, distant metastasis-free survival, and local recurrence-free survival rates were 56.3, 53.4, and 67.2 %, respectively. Multivariate analysis showed that Eastern Cooperative Oncology Group (ECOG) performance score of II (p = 0.033), deep tumor location (p = 0.000), and development of distant metastasis (p = 0.004) were negatively correlated with overall survival, and perioperative radiotherapy and negative microscopic margins were significant factors for local control rates (p = 0.000 for each). Deep tumor location (p = 0.003) was the only adverse factor related to distant metastasis-free survival. Deep tumor location, ECOG performance score of II, and development of distant metastasis carry a poor prognostic implication on overall survival. These will aid clinicians in predicting survival and treatment decision.

<p>Undifferentiated Pleomorphic Sarcoma: Long-Term Follow-Up from a Large Institution</p>

“…There was no significant effect of the deep tumor associated with LRFS in some literature, and our study was in line with them. However, we observed that deep tumor had a worse outcome on MFS, which was consistent with Ozcelik’s study 24…”

“…As for resection quality, our study revealed that R0 resection was a favorable prognostic factor for overall survival and local recurrence survival, while there was no significant difference for MFS between patients with R0 resections and patients with R1/R2 resections. Our results were supported by previous studies,14,16,23,24,26 and these data manifested that clear surgical margin was a favorable prognostic factor for local recurrence. So we tried our best to obtain a clear surgical margin and advocated extended resection for patients who had unplanned resections in our center.…”

“…We classified patients into two groups, the T1 (5cm) group and T2 (>5cm) group. Multivariate analysis revealed that tumor size was an independent prognostic factor for OS, which was in line with Peiper and Ozcelik 16,24. Besides, Roland identified that patient with a tumor smaller than 10cm had a favorable outcome 14.…”

“…According to previous studies, some studies reported that deep tumor was not related to worse OS,14,17,23 while some studies showed that significant difference between deep tumor and superficial tumor on OS or DSS 16,24. In our study, we found that patients with deep tumor had a worse prognosis for OS.…”

Does an Algorithmic Approach to Using Brachytherapy and External Beam Radiation Result in Good Function, Local Control Rates, and Low Morbidity in Patients With Extremity Soft Tissue Sarcoma?

“…Studies vary regarding the efficacy of brachytherapy for local control of extremity soft tissue sarcomas, with extensive variability in tumor grade, size, depth, histologic diagnoses, margin status, and brachytherapy technique. As such, a broad range of local recurrence data exist, ranging between 18% to 78% [22,26,28,42,43,50] for HDR-BT alone, and between 0% and 85% when brachytherapy is combined with EBRT [5,9,12,19,34,36,39,45]. Large series have shown that unplanned excision is associated with an increased risk for local recurrence [47,48].…”