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Myxofibrosarcoma: a retrospective analysis of 158 patients. Sanfilippo R , Grosso F, Pennacchioli E, Barisella M, Fiore M, Morosi C, Collini P, Casali PG, Gronchi A. Roberta Sanfilippo [email protected]. Myxofibrosarcoma. INT, Milano May 1994 - February 2009. - PowerPoint PPT Presentation
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Myxofibrosarcoma:
a retrospective analysis of 158 patients
Sanfilippo R, Grosso F, Pennacchioli E, Barisella M, Fiore M, Morosi C, Collini P, Casali PG, Gronchi A
Roberta [email protected]
Myxofibrosarcoma
INT, Milano May 1994 - February 2009
Patients’ characteristics Median age (I.Q. range) 64 yrs (54-72)
Sex Male 56% Female 44%
Median size(I.Q. range) 5 (3-9) cm
Deep site 56%
Grade (FNCLCC)grade I 22%
grade II 42%
grade III 36%
Patients’ characteristics
Primary tumor
Recurrent tumor
Chemotherapy
Done 14%Not Done 86%
RadiotherapyDone 51% Not Done 49%
Tumor sites
Head&neck 1%
Trunk 14%
Upper extremities 24%
Lower extremities 61%
Surgery
Surgical Procedure
Conservative 157/158
Amputation 1/158 (1/132)
Surgical margins
Negative 82%
Positive 18%
extremities
OS
0 12 24 36 48 60
0.0
0.2
0.4
0.6
0.8
1.0
Time (months)
Su
rviv
al p
rob
abil
ity
OS@5yrs=77%
Median follow-up (from surgery): 53 months
Presentation: recurrent 1.82 (0.79, 4.17) 0.159
vs primary
Depht: deep vs superficial 0.76 (0.30, 1.91) 0.558
Size: 9 vs 3 cm 3.46 (1.13,10.62) 0.005
Grade : III vs II&I 4.76 (2.15, 10.54) <0.0001
Margins: positive vs negative 2.51 (1.08,5.82) 0.032
RT: done vs not done 1.31 (0.58,2.97) 0.522
CT: done vs not done 0.65 (0.22,1.88) 0.422
Multivariate analysis for OS
HR P
LR and M
0 12 24 36 48 60
0.00
0.02
0.04
0.06
0.08
0.10
0.12
0.14
0.16
0.18
0.20
Time (months)
Pro
bab
ilit
yCrude cumulative incidence
Distant metastasis
Local relapse
Median follow-up (from surgery): 53 months
LR@5yrs=18%DM@5yrs=15%
Univariate analysis for LR HR P
Presentation: recurrent 1.03 (0.43, 2.43) 0.95
vs primary
Depht: deep vs superficial 1.50 (0.69,3.28) 0.3081
Size: 9 vs 3 cm 1.23(0.51-2.96) 0.115
Site: extremity vs other 1.56 (0.47, 5.18) 0.4691
Grade : II vs I 0.67 (0.29, 1.55)0.3472
III vs II 0.46 (0.16, 1.35)
Margins: positive vs negative 5.40 (2.46, 11.86) <.0001
RT: done vs not done 1.36 (0.63, 2.91) 0.4321
CT: done vs not done 1.87 (0.64, 5.49) 0.2555
Presentation: recurrent 0.61 (0.23, 1.60) 0.314
vs primary
Depht: deep vs superficial 1.08 (0.41, 2.82) 0.875
Size: 9 vs 3 cm 0.87 (0.30,2.56) 0.859
Margins: positive vs negative 5.63 (2.06,15.38) <0.001**
Grade : III vs II&I 0.80 (0.29, 2.21) 0.662
RT: done vs not done 1.07 (0.47,2.44) 0.863
Multivariate analysis for LR
HR P
Presentation: recurrent 1.74 (0.66, 4.57) 0.264 vs primary
Depht: deep vs superficial 1.55 (0.47, 5.09) 0.475
Size: 9 vs 3 cm 1.18(0.32-4.32) 0.728
Grade : III vs I/II 5.35 (1.93, 14.84) 0.001
Margins: positive vs negative 2.86 (0.90,9.06) 0.074
CT: done vs not done 0.84 (0.27,2.62) 0.760
Multivariate analysis for M
HR P
**
OS Myxofibrosarcoma G3
0 12 24 36 48 60
0.0
0.2
0.4
0.
60
.81
.0
Su
rviv
al p
rob
abil
ity
%
Time (months)
OS@5yrs=64.5%
0 12 24 36 48 60
0.00
0.02
0.04
0.06
0.08
0.10
0.12
0.14
0.16
0.18
0.20
0.22
0.24
0.26
0.28
0.30
Pro
bab
ilit
y
LR and M in G3 Myxofibrosarcoma
Distant metastasis
Local relapse
Time (months)
LR@5yrs=11%DM@5yrs=27%
Patterns of metastasis
20%
“Infiltrative margins”
Positive margins (I.Q. range) 9.5 (5-16.5) cm
Negative margins (I.Q. range)5 (3-7) cm
Median size
Margins and size
Conclusions Myxofibrosarcomas have a good prognosis, and
even high-grade ones have a comparatively low risk of metastases
By contrast, the local relapse rate is definetely higher, likely due to the typically higher infiltrative pattern of growth
However, the local recurrence rate does not seem to influence the outcome
Though in the presence of an obvious selection bias in this series, the role of radiation therapy is left to be defined
