Prognostic factors in soft tissue leiomyosarcoma of the extremities: A retrospective analysis of 42 cases

Department of Human Pathology and Oncology, University of Florence, Viale Morgagni, 85, 50134 Firenze, Italy.
European Journal of Surgical Oncology (Impact Factor: 3.01). 06/2004; 30(5):565-72. DOI: 10.1016/j.ejso.2004.03.002
Source: PubMed


Soft tissue leiomyosarcomas (LMS) are rare tumours which are associated with a poor prognosis. The goals of the present study were to describe the clinico-pathological and prognostic features of 42 patients affected by soft tissue LMS of the extremities.
The following clinical and pathological parameters were analysed: age, sex, site, size, depth, previous surgical procedures, stage, histological type, nuclear atypia, grade, mitotic activity, necrosis, surgical margins, therapy. Disease-free survival rates were calculated.
The overall 2-year and 5-year disease free survival rates were 42.3% and 32.6%, respectively. By univariate analysis, tumour size (< or =10 cm vs. >10 cm; p = 0.01), average mitotic rate (< or =19/10 HPF vs. >19/10 HPF; p = 0.05), type of excision (wide vs. marginal or intralesional; p = 0.001) and adjuvant radiotherapy (none vs. brachytherapy+external beam radiotherapy vs. external beam radiotherapy; p = 0.02) were significantly correlated with disease progression. By multivariate analysis, the only factor that was found to be an independent predictor of disease relapse was type of excision (p = 0.001).
Large tumour size and high mitotic rate resulted adverse prognostic factors. Adjuvant radiation therapy, in combination with wide surgical excision, allowed the best chance of cure.

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    • "Tumor size >10 cm at presentation, mitotic rate >19 per 10 HPF, marginal or intralesional excision, and lack of adjuvant radiotherapy were found to be significant risk factors for progression of leiomyosarcomas located in the extremities. In their series, 2-year and 5-year disease-free survival rates were 42.3% and 32.6%, respectively [1]. Another series of 66 patients over 22 years with leiomyosarcoma arising from the soft tissues of the extremities found that only 16% were located in the upper extremities. "
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    • "Factors that have correlated with adverse prognosis in patients with subcutaneous leiomyosarcoma include tumor size, high mitotic rate, presence of necrosis, deep-seated tumors with fascia involvement and intratumoral vascular invasion.[89111523] Survival for tumors smaller than 2 cm and larger than 5 cm has been reported to be 95% and 30% respectively.[17] "
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    • "Increasing tumor size, grade, and depth correlates with decreased survival [8, 11, 17–20]. Increasing mitotic index has also been shown to adversely affect prognosis [20] [21], but this correlation has not been true in other studies [8] [11] [17] [18]. Interestingly, at least one-quarter [11] to one-third [17] of somatic LMSs originate from a vessel wall but these lesions are distinguished from the major vessel LMS group, which arises in large vessels, most commonly the inferior vena cava (IVC) [22], have a worse prognosis, and pose uniquely challenging clinical management issues. "
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