Department of Dermatology and Venereology, University of Cologne, Cologne, Germany.
Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
J Eur Acad Dermatol Venereol. 2019 Aug;33(8):1577-1580. doi: 10.1111/jdv.15493. Epub 2019 Mar 27.
Pleomorphic dermal sarcomas (PDS) are frequent UV-induced sarcomas of the skin of intermediate grade malignant potential. Despite the fact that PDS have a noteworthy potential to recur (up to 28%) as well as to metastasize (up to 20%), there are no specific clinical guidelines with respect to follow-up these patients. Moreover, little is known about clinical, histological or molecular prognostic factors in PDS.
The aim of the present study was to identify risk factors to predict relapse in a large multicentre sample cohort of PDS which could aid to optimize personalized treatment recommendations regarding surgical safety margins and adjuvant radiotherapy.
Patients with a diagnosis of PDS were selected from nine European institutions based on the histopathologic criteria described by Fletcher. Clinicopathologic and follow-up data were collected and statistically analysed calculating univariate hazard ratios with 95% confidence intervals by use of the Cox proportional-hazards model and a significance level of P < 0.05. Patients with an incomplete excision of the tumour were excluded.
Univariate Cox regression analysis of possible prognostic factors for progression-free survival (PFS) performed in 92 patients revealed that an excision margin of <2 cm is significantly associated with relapse of PDS [hazard ratio 4.478 (95% CI 1.536-13.055), P = 0.006]. Ulceration of the tumour was associated with a significantly better prognosis [0.396 (0.174-0.904), P = 0.028] whereas adjuvant radiotherapy did not reach statistical significance to improve prognosis in patients with PDS [0.775 (0.231-2.593), P = 0.679]. Gender, age, immunosuppression, intratumoural necrosis, tumour location, vertical thickness or horizontal diameter did not significantly influence PFS in PDS.
We identified surgical safety margins of <2 cm and absence of ulceration as risk factors for relapse in patients with PDS. These findings may be implemented into both the primary treatment as well as the further monitoring of patients with PDS.
多形性真皮肉瘤（PDS）是一种常见的由紫外线引起的皮肤间叶性肉瘤，恶性潜能为中度。尽管 PDS 具有明显的复发（高达 28%）和转移（高达 20%）的可能性，但目前尚无针对这些患者的具体随访临床指南。此外，对于 PDS 的临床、组织学或分子预后因素知之甚少。
本研究的目的是在一个大型多中心 PDS 样本队列中确定预测复发的危险因素，以帮助优化针对手术安全边界和辅助放疗的个体化治疗建议。
根据 Fletcher 描述的组织病理学标准，从 9 家欧洲机构中选择 PDS 患者。收集临床病理和随访数据，并进行统计分析，通过 Cox 比例风险模型计算单因素风险比及其 95%置信区间，置信水平 P<0.05。排除肿瘤切除不完全的患者。
对 92 例患者进行的无进展生存（PFS）可能预后因素的单因素 Cox 回归分析显示，切除边缘<2cm 与 PDS 复发显著相关[风险比 4.478（95%CI 1.536-13.055），P=0.006]。肿瘤溃疡与显著改善的预后相关[0.396（0.174-0.904），P=0.028]，而辅助放疗对 PDS 患者的预后改善未达到统计学意义[0.775（0.231-2.593），P=0.679]。性别、年龄、免疫抑制、肿瘤内坏死、肿瘤位置、垂直厚度或水平直径在 PDS 患者的 PFS 中均无显著影响。
我们确定了<2cm 的手术安全边界和无溃疡作为 PDS 患者复发的危险因素。这些发现可以应用于 PDS 患者的初始治疗和进一步监测。
