Prognostic and predictive factors in undifferentiated pleomorphic sarcoma: A long‐term study from a large tertiary care urban center

Abstract

Background and Objectives Undifferentiated pleomorphic sarcoma (UPS) is an aggressive type of soft tissue sarcoma (STS) with high rates of metastatic disease and local recurrence. We sought to identify risk factors for local recurrence, metastasis, and overall death, and assess their impact on overall survival (OS), local recurrence‐free survival (LRFS), and metastasis‐free survival (MFS). Methods A total of 386 cases of UPS treated at our institution from 1980 to 2020 were included. Cox proportional hazards regression was used to identifying risk factors for death, local recurrence, and/or metastasis. Using the Kaplan–Meier method, we assessed OS, LRFS, and MFS. Results Sixty‐six (17%) and 121 (30%) patients with UPS developed local recurrence or metastasis, respectively. Lymph node (LN) involvement was present in 13.5% of patients. The most affected organ in patients with metastatic disease was the lungs (76.9%). Age ≥ 60 (hazard ratio [HR] = 2.42) and size ≥7 cm (HR = 1.52) were some of the significant risk factors for overall death. LN involvement was an important risk factor for both LR (HR = 2.79) and distant metastasis (HR = 5.73). Conclusions UPS displays high rates of metastatic disease and local recurrence. Using a tumor size cutoff value of 7 cm yields superior prognostic value than the standard STS T‐score thresholds. Lymphovascular invasion is an important risk factor for the development of metastasis.

Foot and Ankle Soft Tissue Sarcomas–Treatment and Oncologic Outcomes: A Systematic Review of the Literature

“…In this regard, a recent study on appendicular undifferentiated pleomorphic sarcoma reported that a 7-cm cutoff value provided superior prognostic value compared to standard STS T-score thresholds. 13 Surgical management of these tumors is challenging because of their invasive nature and the complex anatomy of the foot and ankle region. Unlike other anatomic areas, this region lacks clear anatomical barriers between compartments and has a small soft tissue envelope, making limb salvage surgery difficult and often resulting in the need for amputation when achieving negative margins is unlikely.…”

“…In this regard, a recent study on appendicular undifferentiated pleomorphic sarcoma reported that a 7-cm cutoff value provided superior prognostic value compared to standard STS T-score thresholds. 13…”

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

“…In a comprehensive study on UPS, an analysis of 386 cases identified lymph node involvement, age over 60, and tumors larger than 7 cm as significant risk factors for local recurrence and distant metastasis. 40 Another study that investigated overall survival in patients with STS of the extremity and thoracic wall noted that a deep tumor location and a grade higher than 2 were correlated with an increased rate of local recurrence. 32 Additionally, Houdek et al described the commonality of local recurrence and distant disease following wide excision of STS in the foot and ankle, including worse OS in tumors ≥3 cm.…”

“…Chest imaging has often been considered adequate for UPS; however, one study showed that approximately 1/3rd of the cohort of patients with UPS demonstrated bony metastasis in the observation period, and over 40% of those that had metastatic disease on presentation were found to have bony metastasis. 40 These unexpected findings bring to question whether patients with UPS might be better staged/surveilled with bone scintigraphy or PET CT. The authors also highlight the prognostic value of lymphovascular infiltration and postulate that PET CT might be the preferred imaging modality for staging and surveillance in this population.…”

Undifferentiated pleomorphic sarcoma of the spleen: a case report and literature review

“…The generally accepted treatment involves radical surgical resection followed by chemotherapy or radiotherapy, depending on the tumour size or the presence of metastatic disease. Despite such aggressive therapy, recurrence rates range after 5 years range between 10 and 42%, whilst 31 to 40% develop distant metastasis [ 5 ].…”