Prognostic factors and outcomes of patients with myxofibrosarcoma.
BACKGROUND
Myxofibrosarcomas (MFS) are a historically heterogeneous group of tumors that exhibit a propensity for local recurrence. The objectives of this study were to analyze the prognostic factors and outcomes of patients with MFS treated at a single institution.


METHODS
We retrospectively reviewed the records of 69 consecutive patients with pathologically confirmed MFS of the extremities or superficial trunk who underwent surgery from August 1995 to November 2010. Clinicopathologic features, treatments, and patient outcomes were reviewed.


RESULTS
Sixty-nine patients were identified, of whom 38 were men (55%). The median age was 62 years. Sixty-four patients (93%) presented with primary tumors, and 5 patients (7%) presented with locally recurrent tumors. Median tumor size was 6.0 cm, and 44 patients (64%) had grade 3 tumors (FNCLCC [Fédération Nationale des Centres de Lutte Contre le Cancer] classification). Margins were microscopically positive in 14 patients (20%) and negative in 55 patients (80%), including close margins (<1 mm) in 14 patients (20%). Fifty-three patients (77%) received radiotherapy. At a median follow-up of 41 months, there were 11 local (16%) and 11 distant (16%) recurrences. The local and distant 5-year recurrence-free survival rates were 72% and 82%, and the 5-year overall survival was 61%. Increased age (scaled by 0.1; hazard ratio [HR] 1.80, P=0.002) and tumor size (HR 1.12, P=0.004) were negatively correlated with overall survival. Positive/close (<1 mm) margin status (HR 4.34, P=0.030) predicted worsened local recurrence-free survival.


CONCLUSIONS
MFS exhibit a propensity for local recurrence, which is predicted by resection with positive or close margins. Aggressive surgery combined with radiotherapy may contribute to more effective local control.
Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Nicole J
NJ
Look Hong
Department of Orthopedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Francis J
FJ
Hornicek
Department of Orthopedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Kevin A
KA
Raskin
Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Sam S
SS
Yoon
Department of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Jackie
J
Szymonifka
Department of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Beow
B
Yeap
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Yen-Lin
YL
Chen
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Thomas F
TF
DeLaney
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
G Petur
GP
Nielsen
Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
John T
JT
Mullen
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005354:Fibrosarcoma / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009236:Myxosarcoma / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D018365:Neoplasm, Residual; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000556:secondary / Q000628:therapy*; D060726:Torso; D034941:Upper Extremity; D055815:Young Adult