Lee Yonghoon, Guertin Michael P, Summers Spencer, Conway Sheila A, Al Maaieh Mothasem, Yechieli Raphael, Trent Jonathan, Rosenberg Andrew E, Pretell-Mazzini Juan
Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Orthopedic Surgery Resident, Department of Orthopedic Surgery, Jackson Memorial Hospital, Miami, FL, USA.
J Oncol. 2021 Nov 28;2021:1844816. doi: 10.1155/2021/1844816. eCollection 2021.
Myxofibrosarcoma (MFS) is notorious for its infiltrative growth pattern, making wide excisions difficult to achieve. Our objective was to assess the impact of surgical margins and other factors that affected rates of local recurrence (LR), distant metastasis (DM), and overall survival (OS) of individuals undergoing resection for MFS.
We retrospectively reviewed the medical records of 209 patients with appendicular soft tissue sarcomas between January 2012 and June 2018. Of these, 29 patients (14%) were diagnosed with myxofibrosarcoma. These patients underwent a total of 33 resections. The pathological analyses were conducted by an experienced musculoskeletal (MSK) pathologist. Demographics data, operative details, adjuvant therapy, and oncological outcomes were assessed.
Of the 29 patients (33 resections), the overall LR rate was 24% (7/29) and the 2-year LR rate was 17% (5/29). Factors associated with negative oncological outcomes were as follows: tumor size ≤10 cm (2-year local recurrence-free rates (LRFRs), 65%; 95% CI, 44-86%; =0.02) and positive surgical margins grouped with surgical margins ≤0.1 cm (hazard ratio (HR), 11.74; 95% CI, 1.41-97.74; =0.02). Chemotherapy and radiotherapy together increased the 2-year LRFR (LRFR, 100%; 95% CI, 100%, =0.001). Two-year DM and OS rates were 15% and 79%, respectively. Female gender was a predictor of distant metastasis. Local recurrence had a negative impact on overall survival. Intraoperative analysis of resection margin accuracy was 75% (12/16) when non-MSK pathologists were involved but 100% accurate (12/12) when analyzed by an MSK pathologist.
Myxofibrosarcomas showed high LR rates after treatment. Close margins (≤0.1 cm) should be considered as a risk factor for LR, and LR is associated with negative overall survival. Neoadjuvant therapy in terms of combined chemotherapy and radiation therapy associates with decreased LR rates. If intraoperative assessment of margins is to be done, it should be performed by an experienced MSK pathologist.
黏液纤维肉瘤（MFS）因其浸润性生长模式而声名狼藉，使得广泛切除难以实现。我们的目的是评估手术切缘及其他影响黏液纤维肉瘤切除患者局部复发（LR）、远处转移（DM）和总生存期（OS）发生率的因素。
我们回顾性分析了2012年1月至2018年6月期间209例阑尾软组织肉瘤患者的病历。其中，29例（14%）被诊断为黏液纤维肉瘤。这些患者共接受了33次手术切除。病理分析由一位经验丰富的肌肉骨骼（MSK）病理学家进行。评估了人口统计学数据、手术细节、辅助治疗和肿瘤学结局。
在29例患者（33次手术切除）中，总体LR发生率为24%（7/29），2年LR发生率为17%（5/29）。与不良肿瘤学结局相关的因素如下：肿瘤大小≤10 cm（2年局部无复发生存率（LRFRs），为65%；95% CI，44 - 86%；P = 0.02）以及阳性手术切缘合并手术切缘≤0.1 cm（风险比（HR），11.74；95% CI，1.41 - 97.74；P = 0.02）。化疗和放疗联合可提高2年LRFR（LRFR，100%；95% CI，100%，P = 0.001）。2年DM和OS发生率分别为15%和79%。女性是远处转移的一个预测因素。局部复发对总生存期有负面影响。当非MSK病理学家参与时，手术切缘准确性的术中分析为75%（12/16），而由MSK病理学家分析时则为100%准确（12/12）。
黏液纤维肉瘤治疗后显示出较高的LR发生率。切缘接近（≤0.1 cm）应被视为LR的一个风险因素，且LR与不良总生存期相关。新辅助化疗和放疗联合治疗与较低的LR发生率相关。如果要进行术中切缘评估，应由经验丰富的MSK病理学家进行。
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