Prognostic Factors in Liposarcomas: A Retrospective Study of 52 Patients

Yang-Guk Chung; Yong-Koo Kang; Won-Jong Bahk; Seung-Koo Rhee; An-Hi Lee; Jung-Mee Park; Min-Woo Kim

doi:10.5292/jkbjts.2010.16.1.14

Journal List > J Korean Bone Joint Tumor Soc > v.16(1) > 1051967

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Chung, Kang, Bahk, Rhee, Lee, Park, and Kim: Prognostic Factors in Liposarcomas: A Retrospective Study of 52 Patients

Original Article

J Korean Bone Joint Tumor Soc 2010;16(1):14-20.

Published online: 17 December 2010

DOI: https://doi.org/10.5292/jkbjts.2010.16.1.14

Prognostic Factors in Liposarcomas: A Retrospective Study of 52 Patients

Yang-Guk Chung, M.D., Yong-Koo Kang, MD, Won-Jong Bahk, M.D., Seung-Koo Rhee, M.D., An-Hi Lee, M.D.^∗, Jung-Mee Park, M.D., Min-Woo Kim, M.D.

^∗Department of Orthopedic Surgery, Pathology, College of Medicine, The Catholic University of Korea, Suwon, Korea

^†Department of Radiology, College of Medicine, The Catholic University of Korea, Suwon, Korea

Correspondence to: Yong-Koo Kang, M.D. Department of Orthopedic Surgery, St. Vicent Hospital, College of Medicine, The Catholic University of Korea, 93-6, Ji-dong, Paldal-gu, Suwon 442-723, Korea TEL: +82-31-249-7184 FAX: +82-31-254-8228 E-mail: ykang77@hanmail.net

Received 3 April 201016 May 2010 Accepted 30 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate prognostic factors influencing on local recurrence, distant metastasis and event-free survival of liposarcomas.

Materials and Methods

Fifty-two patients managed for liposarcomas since 1993 were analyzed respectively in the view of prognostic influence of patient age, tumor size, location, histologic type, histologic grade, resection type, surgical margin, chemotherapy and radiation therapy on local recurrence, distant metastasis and event-free survival. The mean follow up period was 39 months. The univariate and multivariate regression analysis were performed for statistical evaluation.

Results

The local recurrences occurred in 11 patients (21.2%) and distant metastasis in 4 patients (8%), Event-free survival rate at 4 year follow up was 67%. In univariate analysis, histologic grade, surgical margin, chemotherapy and radiation therapy were significant prognostic factors on local recurrence (p<0.05). However, histologic grade lost its significance in muitivariate analysis. Trunk location revealed higher rate of distant metastasis than extremity location. In univariate analysis on event-free survival. histologic grade and chemotherapy were significant factors (p<0.05). No factor remained significant in multivariate analysis.

Conclusion

Considering selection bias, positive surgical margin was negative prognostic factor on local recurrence. Liposarcomas arisen in trunk revealed higher rate of distant metastasis. There was no independent prognostic factor on event-free survival of patients with liposarcomas.

Keywords: liposarcomas, local recurrence, distant metastasis, event-free survival, prognostic factors

REFERENCES

1. Koea JB, Leung D, Lewis JJ, et al. Histopathologic type: an independent prognostic factor In primary soft tissue sarcoma of the extremity? Ann Surg Oncol. 2003; 10:342–440.

2. Lewis JJ, Leung D, Casper ES, et al. Multifactorial analysis of longterm followup (more than 5 years) of primary extremity sarcoma. Arch Surg. 1999; 134:190–4.

3. Dalal KM, Kattan MW, Antonescu CR, Brennan MF, Singer S. Subtype specific prognostic nanogram for patients with primary liposarcoma of the retroperitoneum, extremity, or trunk. Ann Surg. 2006; 244:381–91.

4. Eilber FC, Eilber FR, Eckardt J, et al. The impact of chemo-theraphy on the survival of patients with high-grade primary extremity liposarcoma. Ann Surg. 2004; 240:686–95.

5. Fiore M, Grosso F, Lo Vullo S, et al. Myxoid/round cell and pleomor phic liposarcomas. Cancer. 2007; 109:2522–31.

6. Heuvel SE, Hoekstra HJ, van Ginkel RJ, Bastiaannet E, Suur-meijer A. Clinicopathologic prognostic factors in myxoid liposarcoma: a retrospective study of 49 patients with longterm followup. Ann Surg Oncol. 2007; 14:222–9.

7. Zagars GK, Goswitz MS, Pollack A. Liposarcoma: outcome and prognostic factors following conservation surgery and radiation therapy. Int J Radiation Oncology Biol Phys. 1996; 36:311–9.

8. Fleming ID, Cooper JS, Henson DE, et al. AJCC Cancer Staging Mannual. 5th ed.Philadelphia: Lippincott-Raven;1997. p. 140–6.

9. Evans HL. Liposarcoma. a study of 55 cases with a reassessment of its classification. Am J Surg Pathol. 1979; 3:507–23.

10. Liu CU, Yen CC, Chen WM, et al. Soft tissue sarcoma of extremities: the prognostic significance of adequate surgical margin in primary operation and reoperation after recurrence. Ann Surg Oncol; [published online 2010 March 9].

11. Singer S, Antonescu CR, Riedel E, Brennan MF. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg. 2003; 238:358–71.

12. Stojadinovic A, Leung D, Hoos A, Jaques D, Lewis J, Brennan M. Analysis of the prognostic significance of microscopic margins in 2084 localized primary adult soft tissue sarcomas. Ann of Surg. 2002; 235:424–34.

13. Trojani M, Contesso G, Coindre JM, et al. Soft tissue sarcoma of adults: study of pathological prognostic variables and definition of a histopathologic grading system. Int J Cancer. 1984; 33:37–42.

14. Antonescu CR, Tschernyavsky SJ, Decuseara R, et al. Prognostic impact of P53 status. TLS-CHOP fusion transcript structure, and histological grade in myxoid liposarcoma: a molecular and clinicopathologic study of 82 cases. Clin Cancer Res. 2001; 7:3977–87.

15. Gebhard S, Coindre JM, Michels JJ, et al. Pleomorphic liposarcoma: clinicopathologic, immunohistochemical, and followup analysis of 63 cases: a study from the French Federation of cancer centers sarcoma group. Am J Surg Pathol. 2002; 26:601–16.

16. Henricks WH, Chu YC, Goldblum Jr, et al. Dedifferentiated liposarcoma: a clinocopathological analysis of 155 cases with a proposal for an expanded definition of dedifferentiation. Am J Surg Pathol. 1997; 21:271–81.

17. Linehan DC, Leung J, Leung D, et al. Influence of biologic factors and anatomic site in completely resected liposarcoma. J Clin Oncol. 2000; 18:1637–43.

18. McComick D, Mentzel T, Beham A, et al. Dedifferentiated liposarcoma: clinocopathologic analysis of 32 cases suggesting a better prognostic subgroup among pleomorphic sarcomas. Am J Surg Pathol. 1994; 18:1213–23.

19. Spillane AJ, Fisher C, Thomas JM. Myxoid liposarcoma-the frequency and the natural history of nonpulmonary soft tissue metastases. Ann Surg Oncol. 1999; 6:389–94.

20. Kim HS, Lee JY, Yi SY, et al. Liposarcoma: exploration of clinical prognostic factors for risk based stratification of therapy. BMC Cancer. 2009; 9:205.

21. Antonescu CR, Ladanyi M. Myxoid liposarcoma. Fletcher CDM, Unni KK, Mertens F, editors. World Health Organization classification of tumors: pathology and genetics of tumors of soft tissue and bone. IARC Press. France: Lyon;2002. p. 40–3.

22. Kilpatrick SE, Doyon J, Choong PF, Sim FH, Nascimento AG. The clinicopathologic spectrum of myxoid and round cell liposarcoma. A study of 95 cases. Cancer. 1996; 77:1450–8.

Figure 1.

The cummulative event free survival rates were 67% at 4 year and 55% at 10 year followup.

Table 1.

Patient Characteristics and Summary of Statistical Analysis

Factors	No of case (%)	No of event			Local recurrence		Distant metastasis		Event-free survival
Factors	No of case (%)	LR	DM	EFS	Uni.V	Mult.V	Uni.V	Mult.V	Uni.V	Mult.V
Age at diagnosis
60 yr>	31 (60)	6	3	22	0.706		0.523		0.920
60 yr<	21 (40)	5	1	15
Size (maximum diameter)
10 cm>	28 (54)	4	2	22	0.473		0.875		0.319
10 cm<	24 (46)	7	2	15
Location
Trunk	15 (29)	5	3	7	0.178		0.034		0.067
Extremity	37 (71)	6	1	30
Histologic type
Well diff.	10 (19)	1	0	9	0.630		0.919		0.057
Myxoid	23 (44)	6	2	15
Round cell	9 (17)	0	2	7
Pleomorphic	6 (12)	2	0	4
Dediff.	4 (8)	2	0	2
Histologic grade
Grade 1	28 (54)	3	2	23	0.037	0.092	0.803	0.009		0.078
Grade 2	14 (27)	4	1	9
Grade 3	10 (19)	4	1	5
Resection type
Wide resec.	45 (87)	10	3	32	0.640		0.491		0.717
Marginal resec.	7 (13)	1	1	5
Margin status
Negative	39 (75)	5	3	31	0.010	0.017	1.000		0.134
Positive	13 (25)	6	1	6
Chemotherapy
Performed	14 (27)	6	1	7	0.010	0.037	1.000	0.022		0.220
Not performed	38 (73)	5	3	30
Radiation Tx
Performed	15 (29)	7	1	7	0.007	0.018	0.800		0.104
Not performed	37 (71)	4	3	30

LR, local recurrence; DM, distant metastasis; EFS, event-free survival; Uni.V, univatiate; Mult.V, multivariate; Well diff., well differentiated; Dediff., dedifferentiated.

Table 2.

Summary of Cases with Local Recurrence

Pt's no	Age/sex	Size (cm)	Location	Type	Grade	Resection	Margin	ChemoTx	RTx.	F/U (Mo)	Outcome
1	21/M	8	Thigh	Myxoid	2	Marginal	Positice	No	Yes	46	NED
2	49/F	12	Thigh	Dediff.	3	Wide	Positive	Yes^∗	Yes	82	NED
3	59/M	3	Thigh	Myxoid	1	Wide	Negative	Yes^∗	Yes^∗	57	NED
4	65/M	9	Thigh	Myxoid	2	Wide	Positive	Yes^∗	No	53	NED
5	63/M	4	Thigh	Pleomorphic	3	Wide	Negative	Yes	Yes	29	AWD
6	74/M	17	Thigh	Myxoid	2	Wide	Positive	Yes	Yes	12	DOD
7	49/F	11	Retroperi.	Myxoid	1	Wide	Negative	No	No	52	NED
8	65/F	17	Pelvis	Myxoid	1	Wide	Positive	No	No	16	AWD
9	62/M	4	Neck	Dediff.	3	Wide	Negative	No	Yes^∗	20	AWD
10	48/F	8	Back	Well diff.	1	Wide	Positive	No	Yes	53	NED
11	39/M	4	Back	Pleomorphic	3	Wide	Negative	Yes^∗	No	46	AWD

ChemoTx, chemotherapy; RTx., radiation therapy; F/U (Mo), follow up (months); Dediff., dedifferentiated; Retroperi., retroperitonium; Well diff., well differentiated; NED, no evidence of disease; AWD, alive with disease; DOD, Died of disease.

^∗ After local recurrence.

Table 3.

Summary of Cases with Distant Metastasis

Pt's no	Age/sex	Size (cm)	Location	Type	Grade	Resection	Margin	ChemoTx	RTx.	F/U (Mo)	Outcome
1	29/F	12	Thigh	Myxoid	2	Wide	Negative	Yes^∗	Yes	20	NED
2	68/M	27	Retroperi.	Myxoid	1	Marginal	Negative	No	No	58	DOD
3	31/M	3	Pelvis	Round cell	3	Wide	Negative	Yes	No	14	DOD
4	33/M	4	Buttock	Myxoid	2	Wide	Positive	No	No	20	AWD

ChemoTx, chemotherapy; RTx., radiation therapy; F/U (Mo), follow up (months); Retroperi., retroperitoneum; NED, no evidence of disease; DOD, died of disease; AWD, alive with disease.

^∗ After local recurrence.

TOOLS

Similar articles