Prognostic Factors for Patients With Undifferentiated High Grade Pleomorphic Sarcoma of the Spine

Abstract

Study Design. Retrospective survival analysis of 44 undifferentiated high grade pleomorphic sarcoma (UPS) of the spine. Objective. To identify factors related to overall survival (OS) and help decision making in the treatment of undifferentiated high grade pleomorphic sarcoma of the spine. Summary of Background Data. UPS is an aggressive malignant tumor rarely originating from the spine. Due to its scarcity, only a few studies had been reported to describe the clinical features, treatments, and outcomes of sporadic cases, devoid of evaluation on prognostic factors. Methods. Enrolled in this survival analysis were 44 patients who underwent surgery and adjuvant therapies from January 1999 to December 2015. Kaplan–Meier methods were applied to estimate the overall survival. A multivariate Cox algorithm was applied to recognize factors independently associated with overall survival. Results. Multivariate analysis suggested that age greater than or equal to 55 years (hazard ratio [HR], 3.923, P < 0.001), Eastern Cooperative Oncology Group (ECOG) score four (HR, 4.656, P < 0.001), and subtotal resection or piecemeal total resection (HR, 4.375, P < 0.001) were independently associated with poor overall survival. Conclusion. We identified independent prognostic factors of UPS of the spine. Subtotal resection or piecemeal total resection, age more than or equal to 55 years and ECOG score four are factors adversely affecting overall survival of patients with UPS of the spine. Level of Evidence: 4

Undifferentiated Pleomorphic Sarcoma of the Spine in a patient with Li-Fraumeni syndrome: a case report

“…Primary UPS arising from the bone is relatively rare. The statistics have shown that skeletal involvement of UPS represents less than 2% of primary malignant bone tumors [3]. In most cases, UPS of the bone develops around knee joints and in proximal femurs and humerus [3,14].…”

“…The statistics have shown that skeletal involvement of UPS represents less than 2% of primary malignant bone tumors [3]. In most cases, UPS of the bone develops around knee joints and in proximal femurs and humerus [3,14]. Only a small number of UPS cases involving the spine have been reported since its rst description in 1975.…”

“…In the treatment of UPS, surgery alone is not su cient and the rate of local recurrence (LR) and distant metastasis is high. LR occurs in between 25-75% of cases [3,15], especially for patients with inadequate margins [14]. Radiotherapy should be considered as an adjuvant therapy, especially for patients with non-wide margins.…”

“…UPS is also less sensitive to the rst-line chemotherapeutics Doxorubicin and Ifosfamide [5]. Lehnhardt et al analyzed 140 patients with UPS in their extremities and found adjuvant chemotherapy to have no effect on prognosis [3,8]. Nevertheless, Weiner et al treated three patients who suffered MFH of the bone with radical resection and adjuvant chemotherapy.…”

“…Many studies have shown that advanced age is an independent risk factor for poor prognosis [26,27]. Lou et al [3]revealed that an age ≥ 55 years were independently associated with poor overall survival in spinal UPS. Therefore, early diagnosis is quite important.…”