Myxoid Liposarcoma: A Single Institute Experience

Cho Wan-Hyeong; Seok Song Won; Hee Han Kang; Jeon Dae-Geun; Kong Chang-Bae; Seung Nam Hee

doi:10.4055/jkoa.2019.54.5.440

Journal List > J Korean Orthop Assoc > v.54(5) > 1136195

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Wan-Hyeong, Won, Kang, Dae-Geun, Chang-Bae, and Hee: Myxoid Liposarcoma: A Single Institute Experience

Original Article

J Korean Orthop Assoc 2019;54(5):440-446.

DOI: https://doi.org/10.4055/jkoa.2019.54.5.440

Myxoid Liposarcoma: A Single Institute Experience

Cho Wan-Hyeong, M.D., Seok Song Won, M.D., Hee Han Kang, M.D.^∗, Jeon Dae-Geun, M.D., Kong Chang-Bae, M.D., Seung Nam Hee, M.D.

Departments of Orthopedic Surgery

∗Pathology, Korea Cancer Center Hospital, Seoul, Korea

Correspondence to: Won Seok Song, M.D. Department of Orthopedic Surgery, Korea Cancer Center Hospital, 75 Nowon-ro, Nowon-gu, Seoul 01812, Korea TEL: +82-2-970-1244 FAX: +82-2-970-2403 E-mail: wssongmd@gmail.com ORCID: https://orcid.org/0000-0003-2852-5581

Received 11 May 201828 August 2018 Accepted 25 November 2018

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:

This study assessed the treatment outcomes of myxoid liposarcoma in the extremities and investigate the prognostic factors.

Materials and Methods:

A total of 91 patients with myxoid liposarcoma (83 primary, 8 recurrent) between 2001 and 2015 were reviewed retrospectively. The local recurrence and metastasis after treatment were examined. The survival rates and prognostic factors affecting the survival were investigated. The mean follow-up was 84 months (range, 5–196 months).

Results:

The overall survival rates at 5-yr and 10-yr were 82% and 74%, respectively. The tumor size (p=0.04), round cell component (p<0.0001), grade (p=0.0002), and local recurrence (p=0.006) affected survival in primary patients. Extrapulmonary metastases were observed in 75.0% (18/24) of metastatic patients and the mean post metastasis survival was 26 months (range, 2–72 months)

Conclusion:

Myxoid liposarcoma developed mainly at the lower extremities. The tumor size, grade, component of round cells, and local recurrence were associated with the prognosis. The unique feature of extrapulmonary metastasis in myxoid liposarcoma should be noted in the treatment and follow-up.

Keywords: liposarcoma, myxoid liposarcoma, prognosis

References

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Figure 1.

Metastatic myxoid liposarcoma case (male/35 years old). (A) Abdomen computed tomography scan (18 months after the initial calf sarcoma excision) shows 4.5×3.0×3.5 cm low attenuated lobulated mass (arrow) in right retroperitoneum, paracolic gutter with indentation of right psoas muscle. (B) Bone scan shows a focal hot uptake lesion (arrow) on the left proximal humerus (left) and subsequent T1-weighted magnetic resonance imaging shows a definite metastatic lesion (right).

Table 1.

Characteristics of the 91 Patients

Characteristic	Value
Sex (male/female)	65/26
Age (yr)	46 (14–86)
Presentation
Primary/Reexcision	83/27
Recurrent	8
Location
L/E	82
U/E	9
Tumor size (cm)	10.7 (2.2–34.0)
<10	40
≥10	41
Unknown	10
Depth
Superficial	14
Deep	77
Grade
1	33
2	44
3	8
Unknown	6
Round cell component
<5%	47
≥5%	38
Unknown	6

Values are presented as number only or median (range). L/E, lower extremity; U/E, upper extremity.

Table 2.

Univariate and Multivariate Survival Analysis of 83 Primary Patients

Variable		Univariate			Multivariate
Variable		5-year survival 95% CI^∗	10-year survival 95% CI^∗	p-value	RR (95% CI) p-value
Sex	Male (n=59)	81.0±10.7	70.6±14.6	0.08
	Female (n=24)	90.4±9.6	90.4±9.6
Age (yr)	<40 (n=29)	89.5±10.5	83.9±15.0	0.57
	≥40 (n=54)	80.3±11.7	73.3±14.2
Tumor size (cm)	<10 (n=40)	90.3±9.7	86.2±12.8	0.04	1
	≥10 (n=38)	75.1±14.2	65.2±18.0		0.19 2.3 (0.7–8.2)
Depth	Superficial (n=14)	100±0	100±0	0.06
	Deep (n=69)	80.3±10.1	71.8±13.1
Round cell component	<5% (n=44)	97.6±2.4	93.8±6.2	<0.0001	1
	≥5% (n=33)	61.2±18.2	49.5±21.1		0.047 5.6 (1.0–30.4)
Grade	1 (n=30)	100.0	94.7±5.3	0.0002	1
	2 (n=41)	73.7±15.0	69.1±16.6		3.2 (0.3–31.2)
	3 (n=6)	44.4±43.6	0±0		0.48 4.7 (0.4–57.6)
Local recurrence	No (n=66)	87.7±8.6	85.4±9.5		1
	Yes (n=17)	70.1±22.0	43.8±32.4	0.006	0.4 1.6 (0.5-4.6)
Chemotherapy	Yes (n=13)	61.5±13.5	61.5±13.5	0.07
	No (n=70)	86.3±4.6	80.3±6.0

CI, confidence interval; RR, relative risk.

^∗ Values are presented as mean±standard deviation.

Table 3.

Time to LR or Metastasis by the Round Cell Component, Metastasis Location of 83 Primary Patients

Variable	Round cell	No. of LR (total=17)	Mean time to LR (mo)	p-value	No. of distant metastasis (total=15)	Mean time to metastasis (mo)	p-value
Round cell component	<5%	7	36	0.008	3	26	0.75
	≥5%	10	15		12	20
Location of metastasis	Pulmonary				4	36	0.03
	Extrapulmonary				11	16

LR, local recurrence.

Table 4.

Previous Studies of Myxoid Liposarcoma

Study (yr)	No. of case	Age (yr)	RC>5% (%)	LR (%)	Metastasis (%)	Extrapulmonary metastasis (%)	% of survival (yr)	F/U (mo)	Prognosis factor
Antonescu et al. (2001)¹²⁾	82	46	43	28	38	67%	NA	44	RC>5%, necrosis (>5%), P53(+)
Dalal et al. (2008)⁵⁾	144	NA	0				86 (12)	NA
Dalal et al.	81	NA	100				55 (12)	NA
(2008)⁵⁾
Fiore et al. (2007)¹¹⁾	269	25	25	24	14	74	77 (10)	119	recurrence (+) Size (>10 cm), grade (>2), margin (+),
ten Heuvel et al.	49	44	17	33	27	77	72 (10)	101	Age (>45 yr), grade, size (>5 cm)
(2007)⁴⁾
Nishida et al. (2010)²²⁾	53	52	0	13	11	50	90 (5)	60	Age (>60 yr)
Fuglø et al. (2013)²¹⁾	45	49	0	18	15	100	69 (10)	102	Metastasis (+)
Knebel et al. (2017)¹³⁾	40	50	NA	22	NA	NA	58 (10)	NA
Current study	91	46	45	21	26	75	74 (10)	84	Size (≥10 cm), RC≥5%, grade (≥2), recurrence (+)

RC, round cell component; LR, local recurrence; F/U, follow-up; NA, not available.

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