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MFH revisited: outcome after surgical treatment of undifferentiated pleomorphic or not otherwise specified (NOS) sarcomas of the extremities—an analysis of 140 patients

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Abstract

Background

Undifferentiated pleomorphic sarcoma/NOS (not otherwise specified; former pleomorphic and storiform MFH) of the extremities is a common malignant soft tissue tumor in adults. The objective of this study is to determine prognostic factors for the outcome after surgical treatment with respect to the recent developments in classification.

Methods

From 1996 to 2004, 140 undifferentiated pleomorphic sarcomas/NOS were identified out of 1,200 soft tissue sarcomas of the extremities that were treated at our institution and recorded in a prospective database. Overall survival (OS) and isolated local recurrence (ILR) were determined by Kaplan–Meier analysis. All tumors were retrospectively analyzed regarding prognostic factors of the disease, including patient’s background (primary or recurrent), histological grade (G2/G3), adjuvant chemotherapy and radiotherapy, size (T1–2) and depth of the tumor, and surgical margins (R0, R1, R2).

Results

In 123 patients, a wide resection was performed (limb-sparing surgery). In nine patients, an amputation was necessary. The overall 5-year survival rate was 72% (median follow up: 52 months). There was a significant difference between the group presenting with primary tumors (5-year survival: 84%, p < 0.05) and recurrent tumors (5-year survival: 62%, p < 0.05). Isolated local recurrence occurred in 36 patients.

Conclusions

In terms of OS and ILR, primary or recurrence, negative surgical margins, size and grading had a highly significant influence, whereas the site of surgery and adjuvant chemotherapy, adjuvant radiation and tumor depth did not. Prognosis for patients with undifferentiated pleomorphic sarcoma of the extremities depends predominantly on adequate wide resection of the primary tumor.

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References

  1. Belal A, Kandil A, Allam A, Khafaga Y, El-Husseiny G, El-Enbaby A, Memon M, Younge D, Moreau P, Gray A, Schultz H (2002) Malignant fibrous histiocytoma: a retrospective study of 109 cases. Am J Clin Oncol 25:16–22

    Article  PubMed  Google Scholar 

  2. Bramwell V, Quirt I, Warr D, Verma S, Young V, Knowling M, Eisenhauer E (1989) Combination chemotherapy with doxorubicin, dacarbazine, and ifosfamide in advanced adult soft tissue sarcoma. Canadian Sarcoma Group—National Cancer Institute of Canada Clinical Trials Group. J Natl Cancer Inst 81:1496–1499

    Article  PubMed  CAS  Google Scholar 

  3. Bramwell VH (1988) Current perspectives in the management of soft-tissue sarcoma. The role of chemotherapy in multimodality therapy. Can J Surg 31:390–396

    PubMed  CAS  Google Scholar 

  4. Coindre JM (1993) Pathology and grading of soft tissue sarcomas. Cancer Treat Res 67:1–22

    PubMed  CAS  Google Scholar 

  5. Dei Tos A (2006) Classification of pleomorphic sarcoma: where are we now? Histopathology 48:51–62

    Article  Google Scholar 

  6. Fletcher CD (1992) Pleomorphic malignant fibrous histiocytoma: fact or fiction? A critical reappraisal based on 159 tumors diagnosed as pleomorphic sarcoma. Am J Surg Pathol 16:213–228

    Article  PubMed  CAS  Google Scholar 

  7. Fletcher CD (2006) The evolving classification of soft tissue tumours: an update based on the new WHO classification. Histopathology 48:3–12

    Article  PubMed  CAS  Google Scholar 

  8. Fletcher CD, Gustafson P, Rydholm A, Willen H, Akerman M (2001) Clinicopathologic re-evaluation of 100 malignant fibrous histiocytomas: prognostic relevance of subclassification. J Clin Oncol 19:3045–3050

    PubMed  CAS  Google Scholar 

  9. Hartmann JT, Oechsle K, Huober J, Jakob A, Azemar M, Horger M, Kanz L, Bokemeyer C (2006) An open label, non-comparative phase II study of gemcitabine as salvage treatment for patients with pretreated adult type soft tissue sarcoma. Invest New Drugs 24:249–253

    Article  PubMed  CAS  Google Scholar 

  10. Hartmann JT, Patel S (2005) New drug developments for patients with metastatic soft tissue sarcoma. Curr Oncol Rep 7:300–306

    Article  PubMed  CAS  Google Scholar 

  11. Issels RD (2006) High-risk soft tissue sarcoma: clinical trial and hyperthermia combined chemotherapy. Int J Hyperthermia 22:235–239

    Article  PubMed  Google Scholar 

  12. Lee SY, Obata Y, Yoshida M, Stockert E, Williamson B, Jungbluth AA, Chen YT, Old LJ, Scanlan MJ (2003) Immunomic analysis of human sarcoma. Proc Natl Acad Sci USA 100:2651–2656

    Article  PubMed  CAS  Google Scholar 

  13. Lee YF, John M, Edwards S, Clark J, Flohr P, Maillard K, Edema M, Baker L, Mangham DC, Grimer R, Wooster R, Thomas JM, Fisher C, Judson I, Cooper CS (2003) Molecular classification of synovial sarcomas, leiomyosarcomas and malignant fibrous histiocytomas by gene expression profiling. Br J Cancer 88:510–515

    Article  PubMed  CAS  Google Scholar 

  14. Lehnhardt M, Daigeler A, Hauser J, Puls A, Soimaru C, Kuhnen C, Steinau HU (2007) The value of expert second opinion in diagnosis of soft tissue sarcomas. J Surg Oncol 97:40–43

    Article  Google Scholar 

  15. Lehnhardt M, Kuhnen C, Drucke D, Homann HH, Joneidi Jafari H, Steinau HU (2004) [Liposarcoma of the extremities: recent developments in surgical therapy. Analysis of 167 patients]. Chirurg 75:1182–1190

    Article  PubMed  CAS  Google Scholar 

  16. Matsumoto S, Ahmed AR, Kawaguchi N, Manabe J, Matsushita Y (2003) Results of surgery for malignant fibrous histiocytomas of soft tissue. Int J Clin Oncol 8:104–109

    Article  PubMed  Google Scholar 

  17. Mentzel T, Bainbridge TC, Katenkamp D (1997) Solitary fibrous tumour: clinicopathological, immunohistochemical, and ultrastructural analysis of 12 cases arising in soft tissues, nasal cavity and nasopharynx, urinary bladder and prostate. Virchows Arch 430:445–453

    Article  PubMed  CAS  Google Scholar 

  18. Mentzel T, Calonje E, Wadden C, Camplejohn RS, Beham A, Smith MA, Fletcher CD (1996) Myxofibrosarcoma. Clinicopathologic analysis of 75 cases with emphasis on the low-grade variant. Am J Surg Pathol 20:391–405

    Article  PubMed  CAS  Google Scholar 

  19. Mentzel T, Fletcher CD (1998) Recent advances in soft tissue tumor diagnosis. Am J Clin Pathol 110:660–670

    PubMed  CAS  Google Scholar 

  20. Mentzel T, Katenkamp D, Fletcher CD (1996) [Low malignancy myxofibrosarcoma versus low malignancy fibromyxoid sarcoma. Distinct entities with similar names but different clinical course]. Pathologe 17:116–121

    Article  PubMed  CAS  Google Scholar 

  21. Nakayama R, Nemoto T, Takahashi H, Ohta T, Kawai A, Seki K, Yoshida T, Toyama Y, Ichikawa H, Hasegawa T (2007) Gene expression analysis of soft tissue sarcomas: characterization and reclassification of malignant fibrous histiocytoma. Mod Pathol 20:749–759

    Article  PubMed  CAS  Google Scholar 

  22. Nielsen TO, West RB, Linn SC, Alter O, Knowling MA, O’Connell JX, Zhu S, Fero M, Sherlock G, Pollack JR, Brown PO, Botstein D, van de Rijn M (2002) Molecular characterisation of soft tissue tumours: a gene expression study. Lancet 359:1301–1307

    Article  PubMed  CAS  Google Scholar 

  23. O’Brien JE, Stout AP (1964) Malignant fibrous xanthomas. Cancer 17:1445–1455

    Article  PubMed  CAS  Google Scholar 

  24. Oda Y, Tamiya S, Oshiro Y, Hachitanda Y, Kinukawa N, Iwamoto Y, Tsuneyoshi M (2002) Reassessment and clinicopathological prognostic factors of malignant fibrous histiocytoma of soft parts. Pathol Int 52:595–606

    Article  PubMed  Google Scholar 

  25. Popov P, Tukiainen E, Asko-Seljavaara S, Huuhtanen R, Virolainen M, Virkkunen P, Blomqvist C (2004) Soft-tissue sarcomas of the upper extremity: surgical treatment and outcome. Plast Reconstr Surg 113:222–230, discussion 231–222

    Article  PubMed  Google Scholar 

  26. Poremba C (2006) [Soft tissue sarcomas: the role of histology and molecular pathology for differential diagnosis]. Verh Dtsch Ges Pathol 90:59–72

    PubMed  CAS  Google Scholar 

  27. Randall RL, Albritton KH, Ferney BJ, Layfield L (2004) Malignant fibrous histiocytoma of soft tissue: an abandoned diagnosis. Am J Orthop 33:602–608

    Article  PubMed  Google Scholar 

  28. Singer S, Demetri GD, Baldini EH, Fletcher CD (2000) Management of soft-tissue sarcomas: an overview and update. Lancet Oncol 1:75–85

    Article  PubMed  CAS  Google Scholar 

  29. Skubitz KM, D’Adamo DR (2007) Sarcoma. Mayo Clin Proc 82:1409–1432

    Article  PubMed  CAS  Google Scholar 

  30. Skubitz KM, Skubitz AP (2003) Differential gene expression in leiomyosarcoma. Cancer 98:1029–1038

    Article  PubMed  CAS  Google Scholar 

  31. Steinau HU, Ehrl H, Biemer E (1988) [Limb-sparing surgery in recurrent soft tissue sarcomas?]. Chirurg 59:265–271

    PubMed  CAS  Google Scholar 

  32. Steinau HU, Hebebrand D, Hussmann J (1993) [Reconstructive possibilities after extensive resection of malignant soft tissue tumors]. Chirurg 64:517–526

    PubMed  CAS  Google Scholar 

  33. Steinau HU, Hebebrand D, Torres A, Vogt P (1998) Surgical management of soft tissue sarcomas: principles of resection and reconstructive plastic procedures. Schweiz Rundsch Med Prax 87:1061–1065

    CAS  Google Scholar 

  34. Steinau HU, Homann HH, Drucke D, Torres A, Soimaru D, Vogt P (2001) Resection method and functional restoration in soft tissue sarcomas of the extremities. Chirurg 72:501–513

    Article  PubMed  CAS  Google Scholar 

  35. Stoeckle E, Kantor G, Thomas L, Coindre JM, Bui BN (2004) Surgery of recurrent soft tissue sarcoma of the extremities and the trunk wall: a comparison to primary sarcoma. Bull Cancer 91:853–860

    PubMed  Google Scholar 

  36. Tos AP (2006) Classification of pleomorphic sarcomas: where are we now? Histopathology 48:51–62

    Article  Google Scholar 

  37. Weiss SW, Enzinger FM (1978) Malignant fibrous histiocytoma: an analysis of 200 cases. Cancer 41:2250–2266

    Article  PubMed  CAS  Google Scholar 

  38. Weiss SW, Enzinger FM (1977) Myxoid variant of malignant fibrous histiocytoma. Cancer 39:1672–1685

    Article  PubMed  CAS  Google Scholar 

  39. Weitz J, Antonescu CR, Brennan MF (2003) Localized extremity soft tissue sarcoma: improved knowledge with unchanged survival over time. J Clin Oncol 21:2719–2725

    Article  PubMed  Google Scholar 

  40. Yamaguchi U, Hasegawa T (2004) [Pathological evaluation of soft tissue sarcoma for diagnosis, prognosis and treatment]. Gan To Kagaku Ryoho 31:1340–1345

    PubMed  Google Scholar 

Download references

Acknowledgement

We thank Renate Klaassen-Mielke, Institute of Biometry and Statistical Analysis, Ruhr University Bochum for his help in statistical analysis.

We thank Amanda Daigeler for her formal English revision of the manuscript.

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Authors and Affiliations

  1. Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Marcus Lehnhardt, Adrien Daigeler, Heinz H. Homann, Vanessa Schwaiberger, Ole Goertz & Hans U. Steinau

  2. Institute of Pathology, Sarcoma Reference Center, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Cornelius Kuhnen

Authors
  1. Marcus Lehnhardt
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  2. Adrien Daigeler
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  3. Heinz H. Homann
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  4. Vanessa Schwaiberger
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  5. Ole Goertz
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  6. Cornelius Kuhnen
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  7. Hans U. Steinau
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Correspondence to Marcus Lehnhardt.

Additional information

Marcus Lehnhardt and Adrien Daigeler contributed equally to the study.

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Lehnhardt, M., Daigeler, A., Homann, H.H. et al. MFH revisited: outcome after surgical treatment of undifferentiated pleomorphic or not otherwise specified (NOS) sarcomas of the extremities—an analysis of 140 patients. Langenbecks Arch Surg 394, 313–320 (2009). https://doi.org/10.1007/s00423-008-0368-5

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