Recurrent abdominal liposarcoma: Analysis of 19 cases and prognostic factors

AIM: To evaluate the clinical outcome of re-operation for recurrent abdominal liposarcoma following multidisciplinary team cooperation.

METHODS: Nineteen consecutive patients who had recurrent abdominal liposarcoma underwent re-operation by the retroperitoneal sarcoma team at our institution from May 2009 to January 2012. Patient demographic and clinical data were reviewed retrospectively. Multidisciplinary team discussions were held prior to treatment, and re-operation was deemed the best treatment. The categories of the extent of resection were as follows: gross total resection (GTR), palliative resection and partial resection. Surgical techniques were divided into discrete lesion resection and combined contiguous multivisceral resection (CMR). Tumor size was determined as the largest diameter of the specimen. Patients were followed up at approximately 3-monthly intervals. For survival analysis, a univariate analysis was performed using the Kaplan-Meier method, and a multivariate analysis was performed using the Cox proportional hazards model.

RESULTS: Nineteen patients with recurrent abdominal liposarcoma (RAL) underwent 32 re-operations at our institute. A total of 51 operations were reviewed with a total follow-up time ranging from 4 to 120 (47.4 ± 34.2) mo. The GTR rate in the CMR group was higher than that in the non-CMR group (P = 0.034). CMR was positively correlated with intra-operative bleeding (correlation coefficient = 0.514, P = 0.010). Six cases with severe postoperative complications were recorded. Patients with tumor sizes greater than 20 cm carried a significant risk of profuse intra-operative bleeding (P = 0.009). The ratio of a highly malignant subtype (dedifferentiated or pleomorphic) in recurrent cases was higher compared to primary cases (P = 0.027). Both single-factor survival using the Kaplan-Meier model and multivariate analysis using the Cox proportional hazards model showed that overall survival was correlated with resection extent and pathological subtype (P < 0.001 and P = 0.02), however, relapse-free interval (RFI) was only correlated with resection extent (P = 0.002).

CONCLUSION: Close follow-up should be conducted in patients with RAL. Early re-operation for relapse is preferred and gross resection most likely prolongs the RFI.

[Combined operations by retroperitoneal liposarcomas]

Retrospective analysis of 228 patients with retroperitoneal liposarcoma, operated on in the Russian Oncology Center during 1971-2010, has been done. Of 223 performed operations, 124 were combined, i.e., required multi-organ resection. The kidney was the most frequently removed organ both in cases of primary and recurrent tumors. 10-year survival rate was 26% after combined operations and 35% after surgery, they did not need the multiorgan resection.

Phase 2 Southwest Oncology Group-directed intergroup trial (S0505) of sorafenib in advanced soft tissue sarcomas

BACKGROUND

Patients with advanced soft tissue sarcomas (STS) have limited therapeutic options. Sorafenib (BAY 43-9006) is a multitargeted tyrosine kinase inhibitor of raf, vascular endothelial growth factor receptors 1 (VEGFR1) through 3, platelet-derived growth factor B, fms-like tyrosine kinase 3, and c-kit, and some of these may be relevant in STS.

METHODS

The authors tested sorafenib at a dose of 400 mg twice daily in patients with advanced vascular sarcoma (VS), high-grade liposarcomas, and leiomyosarcomas who had received 0 or 1 previous regimens for advanced disease.

RESULTS

Fifty-one patients were accrued to the study, and 37 were evaluable for toxicity and response. There were no unexpected side effects and no confirmed responses. The median progression-free survival was 3 months, and the median overall survival was 17 months. Six of 8 patients in the VS cohort had prolonged clinical benefit (stable disease or better), resulting in a median progression-free survival of 5 months compared with 2 to 3 months for the patients who had liposarcoma and leiomyosarcomas.

CONCLUSIONS

Sorafenib at the dose and schedule studied did not result in any responses in the VS, liposarcoma, or leiomyosarcoma cohort according to Response Evaluation Criteria in Solid Tumors.

[Clinico-morphological properties and surgical treatment results in retroperitoneal liposarcomas]

The separate clinico-morphological features of nonorganic retroperitoneal liposarcoma (NRL) and their prognostic value were studied in 200 patients. The type of primary NRL is histologically erentiated in 65.5%, myxoid in 16.1%, dedifferentiated in 9.2%, pleomorphic in 4.6% and mixed in 2.3%. There is a positive elation between overall survival, lyposarcoma hystologic type < 0.007) and completeness of tumor resection (p < 0.0008). Differentiated and myxoid NRL with cell volume less than 5.0% are characterized by better prognosis. Myxoid NRL with cell volume more than 5.0%, dedifferentiated and pleomorphic NRL types are unfavorable prognostic factors. Radical surgical resectio leads to 5-year and 10-year overall survival of 57.5% and 7.8%. Palliative surgery lead to worse results with 3-year and 5-year overall survival of 50.0% and 31.8% respectively. Therefore, the most important prognostic factors in NRL are histological type and completeness of resection.

Advanced well-differentiated/dedifferentiated liposarcomas: role of chemotherapy and survival

BACKGROUND

Data regarding the role of systemic therapy in patients with advanced well-differentiated/dedifferentiated liposarcomas (WDLPS/DDLPS) are limited.

METHODS

From 2000 to 2010, 208 patients with advanced WDLPS/DDLPS received chemotherapy in 11 participating institutions. Clinical and pathological data were collected by reviewing medical records.

RESULTS

Median age was 63 years (range 32-84). Combination chemotherapy was delivered in 85 cases (41%) and single agent in 123 cases (59%), respectively. One hundred and seventy-one patients (82%) received an anthracycline-containing regimen. Using RECIST, objective response was observed in 21 patients (12%), all treated with anthracyclines. Median progression-free survival (PFS) was 4.6 months [95% confidence interval (CI) 3.3-5.9]. On multivariate analysis, age and performance status (PS) were the sole factors significantly associated with poor PFS. Median overall survival (OS) was 15.2 months (95% CI 11.8 -18.7). On multivariate analysis, grade and PS were the sole factors significantly associated with OS.

CONCLUSIONS

Chemotherapy was associated with clinical benefit in 46% of patients with advanced WDLPS/DDLPS. OS remains poor, even though visceral metastatic disease is less frequent than in other sarcomas.

Factors associated with outcome in liposarcomas of the extremities and trunk

PURPOSE

Liposarcomas are malignant tumors that arise from primitive mesenchymal cells rather than mature adipose tissue. We aimed to evaluate the outcomes of patients with extremities and superficial trunk liposarcomas in relation to some clinicopathological factors.

METHODS

Sixty-three surgically treated patients with liposarcoma, with mean age 53 years, were included in this study. The 5-and 10-year survival rates were analyzed with respect to local recurrences, distant metastases and death with the Kaplan-Meier method. Cox models estimated univariate and multivariate hazard ratios for each candidate predictor of interest.

RESULTS

The 5-year overall survival was 77.8% (95% CI 65.5-87.3) and the 10-year overall survival was 63.5% (95% CI 50.4-75.3). The 5-and 10-year recurrence-free survival were 60% and 57%, respectively. The 5-and 10-year metastasis-free survival were 86% and 84%, respectively. In univariate analysis factors that were significantly associated with outcomes were grade III tumors, amputation procedures, use of chemotherapy and development of local recurrences. No significant association was observed in multivariate analysis.

CONCLUSION

Patients with liposarcoma surviving for 5 years, have also a high probability to be alive at 10 years. The development of metastases is observed within the first 5-years from diagnosis. Metastatic disease after that period is rare. The possibility of local recurrence is not negligible after the 5th year of follow up.

Liposarcoma of the extremities: a review of the cases seen and managed in a major tertiary hospital in Singapore

INTRODUCTION

Liposarcoma is one of the more common types of soft tissue sarcomas, presenting with a wide spectrum of clinical behaviour. However, there is little information on the outcome, management and survivability of patients with extremity liposarcoma in Singapore.

METHODS

A retrospective review of all the patients with extremity liposarcoma, diagnosed between 1997 and 2007, was performed. Univariate and multivariate statistics were used on the data to evaluate the clinical presentations, treatment, outcome and survivability of patients seen.

RESULTS

Over a ten-year period, 30 patients were seen for primary liposarcoma of the extremities. Three patients dropped out and 27 were managed and followed-up. Management included surgery and/or radiotherapy. Histological subtypes included 14 (51.9 percent) well-differentiated, five (18.5 percent) myxoid, four (14.8 percent) de-differentiated, and two (7.4 percent) each of round cell and pleomorphic variants. Four patients (14.8 percent) developed local or metastatic recurrent disease. The mean follow-up was 53 months, and the survival rate with primary disease at 53 months was 92.6 percent. The recurrence-free survival for primary disease at 53 months was 85.2 percent.

CONCLUSION

Liposarcoma of the extremities is relatively rare compared to other major soft tissue tumours. It is a highly pleomorphic disease, whose outcome is dependent on the histological subtype. Limb-sparing management includes wide resection of the tumour with/without radiation postoperatively.

Serum albumin is an independent prognostic factor for survival in soft tissue sarcomas

BACKGROUND

Soft tissue sarcomas are rare tumors with a wide clinical spectrum. Prognostic factors for survival have been identified, but they have been focused in the characteristics of the tumor. Patient related variables have not usually been considered in previous analysis.

METHODS

We analyzed a group of 61 patients with soft tissue sarcomas. Tumor related variables and patient related ones were recorded. Overall and disease free survival were calculated according to the Kaplan and Meier method. Prognostic factors for survival were determined by the log-rank method for univariate analysis and the Cox method for multivariate analysis.

RESULTS

Clinical and demographic characteristics are comparable to those of previous reports. Adverse prognostic factors for overall survival in multivariate analysis were advanced stage, high tumor grade, irresecability, and serum albumin. Size, high surgical risk (ASA III-IV) and a low performance status (Karnofsky less than 70) were predictive of overall survival only in univariate analysis. For disease free survival, only high tumor grade had statistical significance.

CONCLUSIONS

Besides the usual tumor related prognostic factors, such as grade and stage, patient related factors, such as performance status and surgical risk should be considered when predicting survival. Specifically, serum albumin was an independent prognostic factor for overall survival.

Prognostic factors and expression of MDM2 in patients with primary extremity liposarcoma

OBJECTIVE

The objective of this study was to investigate MDM2 (murine double minute 2) protein expression and evaluate its relationship with some anatomical and pathological aspects, aiming also to identify prognostic factors concerning local recurrence-free survival, metastasis-free survival and overall survival in patients with primary liposarcomas of the extremities.

MATERIALS AND METHODS

Of 50 patients with primary liposarcomas of the extremities admitted to a Reference Service, between 1968 and 2004, 25 were enrolled in the study, following eligibility and exclusion criteria.

RESULTS

The adverse factors that influenced the risk for local recurrence in the univariant analysis included male sex (P = 0.023), pleomorphic histological subtype (P = 0.027), and high histological grade (P = 0.007). Concerning metastasis-free survival, age less than 50 years (P = 0.040), male sex (P = 0.040), pleomorphic subtype (P < 0.001), and high histological grade (P = 0.003) had a worse prognosis. Adverse factors for overall survival were age under 50 years (P = 0.040), male sex (P = 0.040), pleomorphic subtype (P < 0.001), and high histological grade (P = 0.003).

CONCLUSIONS

There was no correlation between immunohistochemically observed MDM2 protein expressions and the anatomical and pathological variables studied. The immunohistochemical expression of MDM2 protein was not considered to have a prognostic value for any of the surviving patients in this study (local recurrence-free survival, metastasis-free survival, or overall survival). The immunoexpression of MDM2 protein was a frequent event in the different subtypes of liposarcomas.

Matrix metalloproteinase expression in high grade soft tissue sarcomas

Soft tissue sarcomas comprise a heterogeneous group of mesenchymal tumors with varying biological behavior ranging from indolent tumors with no or minimal metastatic risk to aggressive and frequently metastasizing tumors. Among the more common aggressive adult soft tissue sarcomas are malignant fibrous histiocytoma, synovial sarcoma and liposarcoma. Matrix metalloproteinases are enzymes which perform a homeostatic role in mesenchymal tissue and function in both tumorigenesis and metastasis. The objectives of this study are to determine the presence and relative quantity of matrix metalloproteinases (MMPs) -1, -2, -8, -9, and -13; extracellular matrix metalloproteinase inducer (EMMPRIN); and tissue inhibitors of matrix metalloproteinases (TIMP)-1 and -2 in high grade soft tissue sarcoma tumor specimens using real-time PCR. The second objective is to determine if a relationship exists between quantity of EMMPRIN, MMPs, and TIMPs expressed in tumor tissue and disease-free survival. One hundred and forty patients diagnosed with high grade soft tissue sarcomas between 1995-2003 were identified. Tissue blocks and histologic slides were acquired for 41 specimens. Tumor specimens included 29 malignant fibrous histiocytomas, 3 liposarcomas and 11 synovial sarcomas. RNA was extracted and RT-PCR was performed in triplicate. No significant differences were found between the three types of high grade soft tissue sarcomas studied and the expression of MMPs. Interestingly, no relationship was found between high or low levels of MMPs when compared with disease-free survival. Our data support other research which finds variable correlation between MMP expression in soft tissue sarcomas and disease-free survival. We assert that the difference in correlation between MMP expression in carcinomas and sarcomas and disease-free survival is based on the vast phenotypic and genotypic difference between the cells of origin.

Telomere maintenance mechanisms in liposarcomas: association with histologic subtypes and disease progression

Human cancer cells maintain telomeres by telomerase activity (TA) or by alternative lengthening of telomeres (ALT). We proposed to define the prevalence of the two telomere maintenance mechanisms (TMM), to assess their association with histology, and to compare their prognostic relevance in a series of 93 patients with liposarcoma. ALT was detected by assaying ALT-associated promyelocytic leukemia nuclear bodies and TA was assayed using the telomeric repeat amplification protocol. ALT or TA was found in 25.9% or 26.6% of 139 tested liposarcoma lesions, respectively. Three lesions were ALT+/TA+ whereas approximately 50% of lesions did not show any known TMM. TMM phenotype was consistent during disease progression. ALT was prevalent in dedifferentiated and in grade 3 liposarcomas whereas TA prevailed in most round-cell myxoid and in grade 2 liposarcomas. ALT and TA incidence was similar in primary and recurrent lesions whereas metastases were more frequently TA+ than ALT+ (59% versus 18%; P = 0.04). TMM presence negatively affected patient prognosis (P = 0.001): increased mortality was associated with positivity for TA (P = 0.038) or ALT (P < 0.0001) compared with TMM absence. ALT proved to be a stronger prognostic discriminant of increased mortality than TA even when adjusted for tumor location, grade, and histology (hazard ratio for cause-specific death, 3.58 versus 1.15). Our results indicate that ALT can support fully malignant liposarcomas and is associated with unfavorable disease outcome.

Dedifferentiated Liposarcomas With Divergent Myosarcomatous Differentiation Developed in the Internal Trunk

Dedifferentiated liposarcoma (DLPS) is one of the most frequent sarcomas of the retroperitoneum and represents most undifferentiated sarcomas of the internal trunk. In about 5% cases, the dedifferentiated component is an heterologous sarcoma such as leiomyosarcoma or rhabdomyosarcoma. We reviewed a series of 65 sarcomas with a myogenic differentiation developed in the internal trunk for which initial diagnoses were leiomyosarcoma (37), rhabdomyosarcoma (6), malignant mesenchymoma (6), and DLPS (16). Immunostainings for MDM2, CDK4, alpha smooth actin, desmin, caldesmon, myogenin, c-kit, and progesterone receptor were performed. In 48 cases, the amplification status of MDM2 and CDK4 could be evaluated with quantitative polymerase chain reaction on paraffin-embedded tissues extracted DNAs. After review of the cases, final diagnoses were leiomyosarcoma (35), rhabdomyosarcomatous (20) or leiomyosarcomatous (7) DLPS, probable DLPS (2), and malignant mesenchymoma (1). DLPS were bigger tumors (median: 18.2 cm) than leiomyosarcomas (median: 12 cm). They had a lower 5-year recurrence-free survival than leiomyosarcomas (45% vs. 71%) but a higher 5-year metastasis-free survival (73% vs. 39%). There was no significant difference in overall survival (57% vs. 34%). Outcome of patients with a DLPS with a myosarcomatous component did not differ from conventional DLPS. In conclusion, most sarcomas with a rhabdomyosarcomatous differentiation occurring in the internal trunk of adults are DLPS. Moreover, DLPS with a myogenic component have a low metastatic potential, similar to conventional DLPS and significantly lower to the metastatic potential of leiomyosarcomas.

Myxoid/round cell and pleomorphic liposarcomas

BACKGROUND

The objective of this study was to investigate prognostic factors and clinical outcome of myxoid/round cell and pleomorphic liposarcoma.

METHODS

Three hundred twenty-nine patients with localized myxoid/round cell or pleomorphic liposarcoma who underwent surgery at the Istituto Nazionale per lo Studio e la Cura dei Tumori (Milan, Italy) over 25 years were reviewed. The rates of local recurrence, distant metastases, and survival were studied.

RESULTS

Two hundred fourteen patients presented with primary disease, and 115 patients had locally recurrent tumors. The disease-specific survival rate was 75% at 10 years, and the local recurrence and distant metastases incidence were 25% and 15%, respectively. Presentation with recurrent disease, tumor size (>10 cm), tumor grade (French Federation of Cancer Centers grade II or III vs grade I), and positive surgical margins were independent predictors of death. Tumor site and radiation therapy also played a role, mostly related to their effect on local outcome. Pathologic grade and histologic subtype influenced distant metastases. Extrapulmonary metastases were associated with poorer postmetastatic disease-specific survival.

CONCLUSIONS

Myxoid/round cell liposarcomas shared similar prognostic factors with other soft tissue sarcomas and had a relatively good clinical outcome. The presence of >5% of round cell component singled out a group of patients at greater risk of metastases and death but with a broad spectrum of disease aggressiveness. Extrapulmonary metastases were a peculiar pattern of myxoid/round cell liposarcoma that require special consideration for treatment and prognosis.

A 20-year retrospective review of surgically treated liposarcoma at the Cleveland Clinic

The records of 63 patients surgically treated for liposarcoma at the Cleveland Clinic between 1975 and 1995 were examined. Both metastatic disease (Enneking stage IIl) and an abdominal location were found to be poor prognosticants for survival. Age, gender, or tumor size, setting, or grade did not have any prognostic significance. The 5-year disease-specific survival for extremity tumors was 92% (95% confidence interval [CI]; range: 84%-100%), while general 5-year survival for extremity tumors was 66% (95% Cl; range: 48%-85%).

Atypical Lipomatous Tumor, its Variants, and its Combined Forms

Sixty-one cases of neoplasms composed wholly or in part of atypical lipomatous tumor were reviewed. Minimum follow-up was 10 years. The cases were divided into 4 groups based on the findings in the initial excision specimen: conventional atypical lipomatous tumor (n=15), cellular atypical lipomatous tumor (n=21), dedifferentiated liposarcoma (n=24), and atypical lipomatous tumor with a pleomorphic liposarcoma-like component (n=1). The term "cellular atypical lipomatous tumor" was applied to atypical lipomatous tumors having areas of increased cellularity that when non-lipogenic lacked the 5 mitotic figures per 10 high-power fields (maximal rate) required for a dedifferentiated component and when lipogenic fell short of being truly pleomorphic liposarcoma-like. Myxoid regions within this spectrum sometimes had prominent or even plexiform vascularity, creating a resemblance to myxoid liposarcoma especially when interspersed small fat cells were present. The most important prognostic factor was tumor location, as none of the 12 patients with a subcutaneous or intramuscular neoplasm died of tumor. Among the 49 patients with neoplasms of central body sites (mostly retroperitoneum), those with dedifferentiated liposarcoma had significantly shorter survival (median 77 mo) than those with cellular (median 142 mo) or conventional (median 209 mo) atypical lipomatous tumor, whereas there was no statistically significant difference between the latter 2 categories. Patients with atypical lipomatous tumor (either cellular or conventional) in central body sites had significantly shorter survival if the tumor transformed into dedifferentiated liposarcoma in recurrence, and, conversely, those with central body site dedifferentiated liposarcoma had significantly longer survival if it recurred as atypical lipomatous tumor. Metastasis (7 cases) occurred only when the initial specimen or a recurrence demonstrated dedifferentiated liposarcoma.

Subtype specific prognostic nomogram for patients with primary liposarcoma of the retroperitoneum, extremity, or trunk

OBJECTIVE

To determine the prognostic significance of histologic subtype in a large series of patients with primary liposarcoma (LS) and to construct a LS-specific postoperative nomogram for disease-specific survival (DSS).

SUMMARY BACKGROUND DATA

Nomograms, used to define and predict outcome following operative intervention, may contain variables not conventionally used in standard staging systems. A 12-year DSS postoperative nomogram for all sarcomas has already been established.

METHODS

From a single-institution prospective sarcoma database, patients with primary extremity, truncal, or retroperitoneal LS treated between 1982 and 2005 were identified. Histology was reviewed by a sarcoma pathologist and divided into 5 subtypes. A nomogram predictive of 5- and 12-year DSS was developed.

RESULTS

Of 801 patients with primary LS resected with curative intent, 369 (46%) presented with well-differentiated, 143 (18%) dedifferentiated, 144 (18%) myxoid, 81 (10%) round cell, and 64 (8%) pleomorphic histology. The median tumor burden was 15 cm (range, 1-139 cm). At last follow-up, 560 patients were alive with a median follow-up time of 45 months (range, 1-264 months) and 51 months for surviving patients. The 5- and 12-year DSS rates were 83% (95% confidence interval [CI], 80%-86%) and 72% (95% CI, 67%-77%), respectively. The nomogram was drawn on the basis of a Cox regression model. The independent predictors of DSS were age, presentation status, histologic variant, primary site, tumor burden, and gross margin status. The nomogram was internally validated using bootstrapping and shown to have excellent calibration. The concordance index was 0.827 compared with 0.776 for the general sarcoma postoperative nomogram for 12-year DSS.

CONCLUSION

The LS-specific nomogram based on histologic subtype provides more accurate survival predictions for patients with primary LS than the previously established generic sarcoma nomogram. DSS nomograms aid in more accurate counseling of patients, identification of patients appropriate for adjuvant therapy, and stratification of patients for clinical trials and molecular analysis.

[Retroperitoneal sarcomas: diagnostic and therapy]

BACKGROUND

Due to the fact that there are no distinct anatomical compartments, retroperitoneal sarcomas are moreover diagnosed with evidence of large tumors and infiltration of adjacent organs. In spite of improvement of the diagnostic facilities and surgical techniques, quite frequently local recurrences with unfavourable prognosis turn up even after complete removal. It was the aim of this study to analyze diagnosis, therapy and long-term prognosis in patients with retroperitoneal sarcomas over a period of 10 years.

PATIENTS AND METHODS

Between January 1995 and January 2005, 379 patients underwent surgery for a primary retroperitoneal tumor at our clinic. Among the 67 (17.1 %) malignant lesions, a sarcoma was found in 35 patients. The present study is focused on the long-term prognosis of those 21 patients with a primary resected retroperitoneal sarcoma, recurrent sarcomas and exploratory laparotomies excluded.

RESULTS

The median patient age at the time of surgery was 61 (25-86) years, 57.1 % were males. The duration of symptoms was 3 (1-36) months. A pR0-resection was achieved in 20/21 patients. Among the histopathological tumor types, liposarcomas (n = 10) and leiomyosarcomas (n = 6) were found most frequently. Local recurrence developed in 12 out of 21 patients at 13.5 (5-42) months after the first operation, and in 4 patients distant metastases were observed. The long-term survival of all 21 patients with primary resected retroperitoneal sarcoma was 24 (1-101) months. A more favourable prognosis was seen in patients with leiomyosarcoma as compared with liposarcoma.

CONCLUSION

Retroperitoneal sarcomas are a heterogeneous entity, and they were found among our own patients in 6.1 % of all primary operatively treated retroperitoneal tumors. The strategy of treatment is complex and dependent on the stage, localization and histopathological characteristics. Long-term survival is limited as a result of the high rate of local recurrence.

[Liposarcoma of the extremities: recent developments in surgical therapy--analysis of 167 patients]

Liposarcoma is the second most common malignant soft-tissue tumor in adults. Between 1991 and 2002, 167 patients with extremity liposarcomas were treated in our center. Fifty tumors were classified as G1 liposarcomas (30%), 76 as G2 liposarcomas (45.5%), and 41 as G3 liposarcomas (24.5%). In 158 patients, (93.5%) wide tumor excision was performed. Major amputation was necessary in five patients. After a median follow-up of 36 months, 37 patients had developed local recurrence. The 5-year overall survival rate was 79%. The 5-year survival rate in primary tumors was 71/79 (90%, P<0.05) whereas 61/88 of recurrences relapsed locally (69%, P<0.05). Multidisciplinary cooperation in a tumor board is a precondition for adequate treatment.

Salvage surgical resection after high-dose ifosfamide (HDIF) based regimens in advanced soft tissue sarcoma (ASTS): A potential positive selection bias-A study of the Spanish Group for Research on Sarcomas (GEIS)

PURPOSE

To assess the impact of different factors on response rate (RR), time to tumor progression (TTP), and overall survival time (OS) in patients with locally advanced or metastatic soft tissue sarcoma (ASTS), included in three protocols with high-dose ifosfamide (HDIF).

PATIENTS AND METHODS

One hundred fifty six ASTS patients included in three consecutive phase II trials with HDIF (>10 g/m(2)), alone or in combination with doxorubicin (DX), were analyzed. Cofactors were institution, trial, gender, age, performance status, histologic type, grade of malignancy, prior radiotherapy, presence of locoregional disease, metastatic site, salvage surgery, number of organs involved, and disease-free interval.

RESULTS

By multivariate analysis performance status >0 and lack of salvage surgery correlated with a poorer survival. A good-risk and a poor-risk group were identified, with median survival time (OS) of 29, 5, and 10 months, respectively (P = 0.00001). The 1-, 2-, and 3-year OS for 83 good-risk patients (either with PS = 0 or receiving salvage surgery) was 83, 44, and 29%, respectively, those figures being 37, 7, and 3% for 73 poor-risk patients.

CONCLUSION

The design of randomized trials in ASTS including HDIF should consider those prognostic factors as stratification variables.

[The analysis of different treatment methods for 184 cases of soft tissue sarcoma]

OBJECTIVE

To study the proper way of using combined postoperative chemo-radiotherapy and prognostic factors of soft tissue sarcoma.

METHODS

The clinical data of 184 patients were retrospectively reviewed. These patients were devided into surgery group (S, 94 patients), surgery plus postoperative radiotherapy group (S + R, 62 patients) and surgery plus chemotherapy group (S + C, 28 patients).

RESULTS

The 5-year survival rates of S, S + R and S + C groups were 39.4%, 48.4% and 28.6%, respectively. Combined multitherapy was the key to improve survival rate and life quality. Clinical stage, pathological type and therapeutic method were also important prognostic factors for the long term survival.

CONCLUSION

Surgery plus postoperative radiotherapy can improve the 5-year survival rate of soft tissue sarcoma.

Primary malignant tumors of the iliopsoas compartment

BACKGROUND AND OBJECTIVES

Primary malignant tumors of the iliopsoas compartment are rare entities that have been infrequently reported. We present our experience of iliopsoas malignancy to better characterize and define the natural history of this condition.

METHODS

Primary iliopsoas tumors occurring from January 1990 were identified from the Royal Marsden Hospital's (RMH) Sarcoma Unit prospective database.

RESULTS

Nineteen malignant tumors (11 limited to the psoas muscle only, 1 involving only the iliacus muscle and 7 involving both the iliacus and psoas) of the iliopsoas compartment were evaluated and treated at the RMH during this period. Leiomyosarcoma (n = 5) and liposarcoma (n = 3) were the most frequent histologic types. There were 3 G1, 5 G2, 10 G3 tumors and grade could not be assessed in 1 patient. There were 17 T2 tumors and size was not available in 2 patients. Surgery was done in 14 patients (negative microscopic margins-7, positive microscopic margins-3, and positive gross margins-3 and the margin of excision was not known in 1 patient). Five of 14 surgically treated patients had local recurrence and 6 of 19 patients developed metastases. Ten patients died of their disease at a median follow-up of 12 months. The estimated 2 and 5 year survival rates were 44 and 23%, respectively.

CONCLUSIONS

Tumors in this location have a poor prognosis due to the lack of early diagnosis, large size at presentation, multiple attachments of the psoas muscle, and being relatively surgically inaccessible.

Liposarcomas in dogs: 56 cases (1989–2000)

OBJECTIVE

To determine the biological behavior of liposarcomas in dogs and identify clinical signs, the effect of treatment on survival time, and potential prognostic factors.

DESIGN

Retrospective study.

ANIMALS

56 dogs with histologically confirmed liposarcoma.

PROCEDURE

Information was obtained on signalment, tumor size, location of the tumor, stage of disease, remission duration, overall survival time, cause of death, type of surgery (incisional biopsy, marginal excision, or wide excision), and any additional treatments given.

RESULTS

Surgery consisted of incisional biopsy in 6 dogs, marginal excision in 34, and wide excision in 16. Twenty-five dogs had histologic evidence of tumor cells at the surgical margins and 28 did not (status of the margins was unknown in 3 dogs). Twelve of 43 dogs had local recurrence. Median survival time was 694 days, and the only factor significantly associated with survival time was type of surgery performed. Median survival times were 1,188, 649, and 183 days, respectively, for dogs that underwent wide excision, marginal excision, and incisional biopsy. Factors that were not found to be significantly associated with survival time included tumor size, status of the margins, tumor location, and histologic subtype.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that in dogs, liposarcomas are locally invasive neoplasms that rarely metastasize and occur primarily in appendicular or axial locations and that wide excision is preferred to marginal excision when feasible.

Atypical lipomatous tumor/well-differentiated liposarcoma of the extremity and trunk wall: Importance of histological subtype with treatment recommendations

BACKGROUND

This study defines the behavior and classification of atypical lipomatous tumors (ALT) and well-differentiated liposarcomas (WDLS) of the extremity and trunk.

METHODS

A total of 91 well-differentiated lipomatous tumors of the extremity and trunk were identified from a soft tissue tumor database between July 1982 and June 2001. A soft tissue pathologist, blinded to prior diagnosis and clinical outcome, reviewed histology. Those composed predominantly of mature adipose tissue with scattered atypical stromal cells and scant lipoblasts or fibrosis were ALTs. Tumors with lipoblasts but <25% fibrosis were termed lipoma-like WDLS, and those with >/=25% fibrosis were identified as sclerosing WDLS. Clinical factors were analyzed to assess effects on local recurrence-free survival (LRFS).

RESULTS

Histological review identified 34 ALTs and 57 WDLSs. Of the WDLSs, 29 were lipoma-like and 28 were sclerosing. Five-year and 10-year LRFS were 100% +/- 0% and 78% +/- 9%, respectively. Factors evaluated were age, sex, tumor site, tumor size, histology, presentation status, margin status, and adjuvant radiotherapy. Positive resection margins and sclerosing histology were associated with reduced LRFS. Dedifferentiation was observed in three tumors (3%).

CONCLUSIONS

Lipoma-like WDLSs and ALTs share similar histological features and favorable behavior. Margin-positive sclerosing WDLSs have a 10-year LRFS of only 17% and should undergo function-preserving re-excision when possible, or adjuvant radiotherapy.

Primary Dedifferentiated Liposarcoma of the Retroperitoneum

OBJECTIVES

To describe computed tomography (CT) and magnetic resonance (MR) imaging findings and to determine the prognostic significance of radiologic appearances in primary dedifferentiated liposarcoma of the retroperitoneum.

METHODS

Initial CT and MR imaging studies of 20 pathologically confirmed cases of primary dedifferentiated liposarcoma of the retroperitoneum were retrospectively reviewed and assessed for correlations with the histopathologic features. CT and MR images were evaluated by 2 radiologists with agreement by consensus, and univariate analyses were conducted to evaluate survival with a mean clinical follow-up duration of 47 months (range, 5-114 months).

RESULTS

Tumor invasion was more frequent in the anterior or posterior pararenal originating tumors than in pararenal tumors (P<0.05). Well-defined nonlipomatous masses juxtaposed with fatty tumors were identified in all cases. Calcification or ossification was seen in 6 patients (30%) on unenhanced CT. Imaging findings including attenuation, signal characteristics, and enhancement patterns of nonlipomatous masses were nonspecific regardless of histologic variances. Recurrent tumors (n=6) tended to invade surrounding organs. Univariate analysis revealed that calcification or ossification (P<0.05) and first recurrence with duration of a mean 13 months (P<0.05) identified by imaging studies had significant impacts on overall survival.

CONCLUSIONS

Calcification or ossification and first recurrence identified by CT and MR imaging studies are significant adverse prognostic factors in primary dedifferentiated liposarcoma of the retroperitoneum.

Histopathologic type: an independent prognostic factor in primary soft tissue sarcoma of the extremity?

BACKGROUND

We attempted to define the effect of tumor histotype on local recurrence, distant metastasis, and disease-specific survival in patients with surgically treated primary extremity sarcoma.

METHODS

A total of 951 patients with primary, localized soft tissue extremity sarcoma were followed up prospectively. Patient- and tumor-related variables, including histopathologic type, were used to identify independent prognostic factors for the study end points of local recurrence, distant recurrence, and disease-specific survival.

RESULTS

There were 137 local recurrences, and significant adverse prognostic factors for local recurrence were patient age >50 years, microscopically positive margins, and malignant peripheral nerve tumor. Adverse prognostic factors for distant recurrence (200 patients) were tumor size >5 cm, tumors beneath the investing fascia, high tumor grade, and leiomyosarcoma. Of the 199 patients who died of disease-related causes, patient age >50 years, tumors beneath the investing fascia, high tumor grade, microscopically positive margin, tumor size >5 cm, leiomyosarcoma, and malignant peripheral nerve tumor were adverse prognostic factors.

CONCLUSIONS

These data suggest that differences in biological behavior may exist between sarcoma histotypes and deserve further study.