Prognostic factors in soft tissue leiomyosarcoma of the extremities: a retrospective analysis of 42 cases.
OBJECTIVE
Soft tissue leiomyosarcomas (LMS) are rare tumours which are associated with a poor prognosis. The goals of the present study were to describe the clinico-pathological and prognostic features of 42 patients affected by soft tissue LMS of the extremities.


METHODS
The following clinical and pathological parameters were analysed: age, sex, site, size, depth, previous surgical procedures, stage, histological type, nuclear atypia, grade, mitotic activity, necrosis, surgical margins, therapy. Disease-free survival rates were calculated.


RESULTS
The overall 2-year and 5-year disease free survival rates were 42.3% and 32.6%, respectively. By univariate analysis, tumour size (< or =10 cm vs. >10 cm; p = 0.01), average mitotic rate (< or =19/10 HPF vs. >19/10 HPF; p = 0.05), type of excision (wide vs. marginal or intralesional; p = 0.001) and adjuvant radiotherapy (none vs. brachytherapy+external beam radiotherapy vs. external beam radiotherapy; p = 0.02) were significantly correlated with disease progression. By multivariate analysis, the only factor that was found to be an independent predictor of disease relapse was type of excision (p = 0.001).


CONCLUSIONS
Large tumour size and high mitotic rate resulted adverse prognostic factors. Adjuvant radiation therapy, in combination with wide surgical excision, allowed the best chance of cure.
Massi
D
D
Department of Human Pathology and Oncology, University of Florence, Viale Morgagni, 85, 50134 Firenze, Italy.
Beltrami
G
G
Mela
M M
MM
Pertici
M
M
Capanna
R
R
Franchi
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005121:Extremities / Q000473:pathology* / Q000528:radiation effects; D005260:Female; D005500:Follow-Up Studies; D018219:Histiocytoma, Benign Fibrous / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D013514:Surgical Procedures, Operative