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1
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Winer LK, Akumuo R, Fredette JD, Deng M, Hasler JS, Greco SH, von Mehren M, Bartholomew AJ, Blazer DG, Gabrielova L, Adamkova D, Bernard-Bedard E, Nessim C, Kollár A, Olariu R, Cencelj-Arnez R, Hompes D, Ford SJ, Cardona K, Sato K, Iwata S, Farma JM, Villano AM. Current patterns of care and outcomes for dermatofibrosarcoma protuberans: An international multi-institutional collaborative. Cancer 2024. [PMID: 38985726 DOI: 10.1002/cncr.35468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/26/2024] [Accepted: 05/31/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a cutaneous sarcoma with an infiltrative growth pattern that makes it challenging to clear margins. High quality data regarding DFSP natural history, management, and outcomes are limited. METHODS Data were retrospectively collected for adult DFSP patients who underwent resection at 10 institutions in eight countries. Demographics, tumor characteristics, treatment strategies, and outcomes were analyzed. RESULTS Analysis included 347 patients consisting of young (median, 42 years), White (76.2%), males (54.2%) with truncal lesions (57.3%). The majority (76.8%) were symptomatic at presentation. Preoperative imaging was used in 55.9% of cases. Diagnosis was established with excisional biopsy in 50.9% versus incisional biopsy in 25.0% of cases. Despite planned margins of >1.0 cm in 67.4% of cases, only 69.0% of patients achieved R0 resection. Twenty-two percent of patients underwent at least one re-excision. R0 resection was achieved at a second procedure in 80.2% and a third procedure in 86.2%. Ultimately, R0 resection was feasible in 89.5% of all patients. Fibrosarcomatous transformation (FST) was observed in 12.6%. In total, 6.6% (N = 23) recurred (17 local, six distant). Of the six distant recurrences, 50.0% had FST. With a median follow-up of 47.0 months, disease-specific survival rate was 98.8%. In multivariable analysis, R0 margins at index resection were associated with wider circumferential margins and non-FST histology. CONCLUSIONS In this international, multicenter collaborative, DFSP practice patterns were heterogeneous but achieved favorable recurrence rates and survival. Multiple excisions to clear margins remain commonplace and can inform future efforts to optimize margin selection.
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Affiliation(s)
- Leah K Winer
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Rita Akumuo
- Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Jordan D Fredette
- Division of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mengying Deng
- Division of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jill S Hasler
- Division of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Stephanie H Greco
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Margaret von Mehren
- Division of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Alex J Bartholomew
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - Dan G Blazer
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - Lucie Gabrielova
- Department of Surgery, Masaryk Memorial Cancer Institute, Brno, Zluty kopec, Czech Republic
| | - Dagmar Adamkova
- Department of Surgery, Masaryk Memorial Cancer Institute, Brno, Zluty kopec, Czech Republic
| | | | - Carolyn Nessim
- Division of Surgical Oncology, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Attila Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, Univesity of Bern, Bern, Switzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, Freiburgstrasse, Switzerland
| | - Romi Cencelj-Arnez
- Division of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Samuel J Ford
- Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Kenneth Cardona
- Division of Surgical Oncology, Emory University Hospital, Atlanta, Georgia, USA
| | - Kenji Sato
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jeffrey M Farma
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Anthony M Villano
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Dai Z, He Y, Zhang X, Tian Z, Zhu G, Ren Z, Ye L, Liu Z, Ma C, Cao W, Ji T. Head-and-neck dermatofibrosarcoma protuberans: Survival analysis and Clinically relevant immunohistochemical indicators. Oral Dis 2024; 30:1040-1051. [PMID: 36597156 DOI: 10.1111/odi.14495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/28/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Head and neck dermatofibrosarcoma protuberans (HNDFSP) is extremely rare and not entirely understood. OBJECTIVE To investigate the clinicopathological features of HNDFSP and identify the expression of its clinically relevant indicators, with the expectation of improving the existing treatment strategies. METHODS A long-term follow-up of patients with HNDFSP who received treatment between 2000 and 2021 at Shanghai Ninth People's Hospital was conducted. The clinical, histological, and immunohistochemical data of the patients were retrieved and analyzed. The endpoint of the study was the incidence of significant disease-related clinical events (recurrences or metastasis). RESULTS A total of 49 patients with HNDFSP were included in the study, with males (92.7%) predominating than females (7.3%). Eighteen patients developed recurrent disease (36.8%) after surgery, and the median time of recurrence was 48 months (interquartile, 20-74 months). Metastasis occurred in two cases (4.1%). Two patients died during follow-up, both with local recurrence, and one of them with intestinal metastasis. Post-operation radiotherapy was administered to eight patients (16.3%) and the effect in local control was remarkable. Age, tumor size, and negative margins with sufficient safety width were the main independent factors affecting the disease-free survival. Several potential targeted therapeutic indicators, including EZH2 (80.0%), EGFR (91.4%), PDGF (97.1%), PD-L1 (77.1%), and VEGF (77.1%), were positively expressed in most tumor samples. CONCLUSION HNDFSP is rare, significantly challenging to control locally, and has a worse prognosis with current treatment strategies. Wide local excision and long-term follow-up are needed. Radiotherapy could improve the prognosis of patients with HNDFSP.
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Affiliation(s)
- Zhenlin Dai
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Youya He
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Xu Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Zhen Tian
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guopei Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Zhenhu Ren
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Lulu Ye
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Zheqi Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Chunyue Ma
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Wei Cao
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
| | - Tong Ji
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Disease, Shanghai, China
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Houdek MT, Wunder JS. ASO Author Reflections: Improving Management Strategies for Patients with Primary Dermatofibrosarcoma Protuberans (DFSP). Ann Surg Oncol 2022; 29:8639-8640. [PMID: 35969303 DOI: 10.1245/s10434-022-12397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
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Houdek MT, Tsoi KM, Mallett KE, Claxton RM, Ferguson PC, Griffin AM, Baum CL, Brewer JD, Rose PS, Wunder JS. Surgical Outcomes of Primary Dermatofibrosarcoma Protuberans: A Retrospective, Multicenter Study. Ann Surg Oncol 2022; 29:8632-8638. [PMID: 35933538 DOI: 10.1245/s10434-022-12351-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive tumor with a low rate of metastatic disease. Previous series have shown a superiority of Mohs micrographic surgery (MMS) compared with wide local excision (WLE). Likewise, there is paucity of data examining the long-term follow-up of patients. OBJECTIVE The purpose of the current study was to examine the outcome of surgical treatment of primary DFSP of the trunk and extremities. METHODS We reviewed 236 patients (115 females, 121 males, mean age 41 ± 15 years) undergoing MMS (n = 81, 34%) or WLE (n = 155, 66%) to treat a primary DFSP. Mean tumor size and follow-up was 4 ± 2 cm and 7 years, respectively. Final margins were negative in 230 (97%) patients. RESULTS There was no difference (p > 0.05) in patient age, sex, tumor size, negative margin excision, or history of a previous inadvertent excision between patients who underwent WLE and those undergoing MMS. There were two cases of local recurrence and two cases of metastasis, with no difference in the 5-year local recurrence-free survival (98% vs. 99%, p = 0.69) or metastatic-free survival (98% vs. 100%, p= 0.27) between WLE and MMS. CONCLUSION There was no difference in oncologic outcome comparing MMS with WLE for DFSP outside the head and neck. The goal of treatment for DFSP is to achieve a negative margin, regardless of surgical treatment modalities. A 'less is more' approach to follow-up can likely be taken for patients with completely resected DFSP in easy-to-examine anatomical areas. In these patients, no formal follow-up should be required.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Kim M Tsoi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | - Anthony M Griffin
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
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Pudasaini P, Paudel S, Adhikari S, Kafle M. DermatoFibroSarcoma Protuberans: A case report of a complete cure. Clin Case Rep 2022; 10:e6218. [PMID: 35957797 PMCID: PMC9364325 DOI: 10.1002/ccr3.6218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/17/2022] [Accepted: 07/23/2022] [Indexed: 11/11/2022] Open
Abstract
DermatoFibroSarcoma Protuberans (DFSP) is a rare recurrent fibrohistiocytic tumor. Given the limitation of available diagnostic modalities in a resource poor setting, diagnosis can be confusing. As most of the tumors recur with time, our case of complete cure was interesting phenomenon observed in our case.
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Perazzoli S, Bonamigo RR, Heck R, Cartell ADS. Tumor in the plantar region: dermatofibrosarcoma protuberans in an infrequent topography. An Bras Dermatol 2020; 95:728-730. [PMID: 32883548 PMCID: PMC7672393 DOI: 10.1016/j.abd.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022] Open
Abstract
Dermatofibrosarcoma protuberans is a rare mesenchymal tumor; it is locally aggressive and presents high rates of local recurrence. It may present as a nodular or plaque vegetating lesion. It mainly affects the trunk and proximal limbs, being rare in the distal extremities. Biopsy and immunohistochemistry help confirm the diagnosis. The authors report a case of dermatofibrosarcoma protuberans with plantar region involvement, a rare presentation. To the best of the authors’ knowledge, only 11 cases of involvement of the feet were described in the international literature.
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Affiliation(s)
- Simone Perazzoli
- Sanitary Dermatology Outpatient Clinic, Porto Alegre, RS, Brazil.
| | - Renan Rangel Bonamigo
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Sanitary Dermatology Service, Secretaria Estadual de Saúde do Estado do Rio Grande do Sul e Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Renata Heck
- Sanitary Dermatology Outpatient Clinic, Porto Alegre, RS, Brazil
| | - André da Silva Cartell
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical Residence in Pathological Anatomy, Hospital de Clínicas, Porto Alegre, RS, Brazil
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Elective localization at the upper left chest of Dermatofibrosarcoma Protuberans. J Plast Reconstr Aesthet Surg 2020; 73:e4-e5. [PMID: 32593573 DOI: 10.1016/j.bjps.2020.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/16/2020] [Indexed: 11/23/2022]
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