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

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.

Atypical Fibroxanthoma: Outcomes from a Large Single Institution Series

“…A recent meta-analysis of 598 patients noted a 1-year recurrence risk of 3.2%, which is lower than our cohort, but the 5 year recurrence rate was much higher at 7.3%. 27 The final limitation is the inability to run statistical analysis via the cox-regression.…”

Immunohistochemical Characteristics of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: A Systematic Review and Meta-Analysis

“…Patients with AFX usually experience a more benign clinical course with risks limited to local recurrence, whereas PDS is considered more invasive and aggressive due to a high risk of local recurrence and metastases. [1][2][3][4] The main features that differentiate PDS from AFX are deep invasion of the subcutis, tumor necrosis, and vascular, perineural, or perilymphatic invasion. 1,5,6 Currently, there are no reliable discriminatory immunomarkers that distinguish AFX from PDS.…”

“…Patients with AFX usually experience a more benign clinical course with risks limited to local recurrence, whereas PDS is considered more invasive and aggressive due to a high risk of local recurrence and metastases. 1–4…”

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

“…However, very few retrospective studies have compared these 2 surgical modalities, and some did not find meaningful differences in the rates of recurrence. 2 The aim of this study was to compare the rates of recurrence and survival between MMS and WLE for AFX.…”

“…Furthermore, our univariate analysis showed that higher comorbidity scores were associated with recurrence, while prior reports suggest that ages >74 and male sex are also risk factors for recurrence. 2 …”