TY - JOUR
T1 - Undifferentiated pleomorphic sarcoma
T2 - Factors predictive of adverse outcomes
AU - Winchester, Daniel
AU - Lehman, Julia
AU - Tello, Tiffany
AU - Chimato, Nicolette
AU - Hocker, Thomas
AU - Kim, Sunhee
AU - Chang, Joseph
AU - Markey, Jeffrey
AU - Yom, Sue S.
AU - Ryan, William
AU - Mully, Thaddeus
AU - Hodge, David
AU - Otley, Clark
AU - Arron, Sarah T.
N1 - Publisher Copyright:
© 2018
PY - 2018/11
Y1 - 2018/11
N2 - Background: Undifferentiated pleomorphic sarcoma (UPS) encompasses rare neoplasms that can arise either in the dermis or in the subfascial soft tissue. The behavior of UPS ranges from indolent to aggressive, but data predicting outcomes are limited. Objective: Identify predictors of poor outcomes by analyzing a large collection of UPS cases. Methods: We evaluated all available cases of UPS (including those termed atypical fibroxanthoma, malignant fibrous histiocytoma, pleomorphic dermal sarcoma, and subfascial UPS) across 3 tertiary care centers. Results: Among the 319 patients, 45 experienced recurrence, 33 experienced metastasis, and 96 died of any cause. Risk factors for recurrence were clinical tumor size larger than 5 cm and invasion beyond subcutaneous fat. Risk factors for distant metastases were tumor site, tumor size larger than 2 cm, invasion beyond subcutaneous fat, and lymphovascular invasion. Risk factors for overall mortality were age, immunosuppression, tumor size larger than 2 cm, and lymphovascular invasion. History of skin cancer was associated with a lower risk of recurrence and metastasis. Limitations: This was a retrospective study. Conclusions: Using the unbiased approach of pooling all UPS cases regardless of terminology, we identified clinical and histologic factors predicting poor outcomes. We propose subcategorization of UPS (into superficial versus deep UPS), which is consistent with the American Joint Committee on Cancer staging of soft-tissue sarcoma.
AB - Background: Undifferentiated pleomorphic sarcoma (UPS) encompasses rare neoplasms that can arise either in the dermis or in the subfascial soft tissue. The behavior of UPS ranges from indolent to aggressive, but data predicting outcomes are limited. Objective: Identify predictors of poor outcomes by analyzing a large collection of UPS cases. Methods: We evaluated all available cases of UPS (including those termed atypical fibroxanthoma, malignant fibrous histiocytoma, pleomorphic dermal sarcoma, and subfascial UPS) across 3 tertiary care centers. Results: Among the 319 patients, 45 experienced recurrence, 33 experienced metastasis, and 96 died of any cause. Risk factors for recurrence were clinical tumor size larger than 5 cm and invasion beyond subcutaneous fat. Risk factors for distant metastases were tumor site, tumor size larger than 2 cm, invasion beyond subcutaneous fat, and lymphovascular invasion. Risk factors for overall mortality were age, immunosuppression, tumor size larger than 2 cm, and lymphovascular invasion. History of skin cancer was associated with a lower risk of recurrence and metastasis. Limitations: This was a retrospective study. Conclusions: Using the unbiased approach of pooling all UPS cases regardless of terminology, we identified clinical and histologic factors predicting poor outcomes. We propose subcategorization of UPS (into superficial versus deep UPS), which is consistent with the American Joint Committee on Cancer staging of soft-tissue sarcoma.
KW - atypical fibroxanthoma
KW - malignant fibrous histiocytoma
KW - pleomorphic dermal sarcoma
KW - undifferentiated pleomorphic sarcoma
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U2 - 10.1016/j.jaad.2018.05.022
DO - 10.1016/j.jaad.2018.05.022
M3 - Article
C2 - 29787841
AN - SCOPUS:85053067035
SN - 0190-9622
VL - 79
SP - 853
EP - 859
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 5
ER -