Dedifferentiated liposarcoma in the extremity and trunk wall: A multi-institutional study of 132 cases by the Japanese Musculoskeletal Oncology Group (JMOG)

Takeshi Morii; Ukei Anazawa; Chiaki Sato; Shintaro Iwata; Makoto Nakagawa; Makoto Endo; Tomoki Nakamura; Kunihiro Ikuta; Yoshihiro Nishida; Robert Nakayama; Toru Udaka; Teruya Kawamoto; Munehisa Kito; Kenji Sato; Jungo Imanishi; Toru Akiyama; Hiroshi Kobayashi; Akihito Nagano; Hidetatsu Outani; Shunichi Toki; Toshihiko Nishisho; Keita Sasa; Yoshiyuki Suehara; Hirotaka Kawano; Takafumi Ueda; Hideo Morioka

doi:10.1016/j.ejso.2022.08.024

Dedifferentiated liposarcoma in the extremity and trunk wall: A multi-institutional study of 132 cases by the Japanese Musculoskeletal Oncology Group (JMOG)

Eur J Surg Oncol. 2023 Feb;49(2):353-361. doi: 10.1016/j.ejso.2022.08.024. Epub 2022 Sep 1.

Authors

Takeshi Morii¹, Ukei Anazawa², Chiaki Sato³, Shintaro Iwata³, Makoto Nakagawa⁴, Makoto Endo⁴, Tomoki Nakamura⁵, Kunihiro Ikuta⁶, Yoshihiro Nishida⁶, Robert Nakayama⁷, Toru Udaka⁸, Teruya Kawamoto⁹, Munehisa Kito¹⁰, Kenji Sato¹¹, Jungo Imanishi¹¹, Toru Akiyama¹², Hiroshi Kobayashi¹³, Akihito Nagano¹⁴, Hidetatsu Outani¹⁵, Shunichi Toki¹⁶, Toshihiko Nishisho¹⁶, Keita Sasa¹⁷, Yoshiyuki Suehara¹⁷, Hirotaka Kawano¹¹, Takafumi Ueda¹⁸, Hideo Morioka¹⁹

Affiliations

¹ Department of Orthopaedic Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan. Electronic address: dr.t.morii@gmail.com.
² Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.
³ Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
⁴ Department of Orthopaedic Surgery, Kyushu University School of Medicine, 3-1-1 Maidashi, Hagashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.
⁵ Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
⁶ Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
⁷ Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
⁸ Department of Orthopaedic Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
⁹ Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
¹⁰ Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
¹¹ Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.
¹² Departments of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
¹³ Department of Orthopaedic Surgery, The University of Tokyo Faculty of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
¹⁴ Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
¹⁵ Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
¹⁶ Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, Tokushima, 770-8503, Japan.
¹⁷ Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
¹⁸ Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
¹⁹ Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.

PMID: 36088237
DOI: 10.1016/j.ejso.2022.08.024

Abstract

Background: Dedifferentiated liposarcoma occurs predominantly in the retroperitoneum. Given the paucity of cases, information on the clinical characteristics of this entity in the extremities and trunk wall is quite limited. In particular, the significance of preoperative evaluation and principles of intraoperative management of the different components, i.e., well-differentiated and dedifferentiated areas, are still to be defined.

Methods: Clinical characteristics, treatment outcomes, and risk factors for poor oncological outcomes in cases of dedifferentiated liposarcoma in the extremity or trunk wall were analyzed by a retrospective, multicentric study.

Results: A total of 132 patients were included. The mean duration from the initial presentation to dedifferentiation was 101 months in dedifferentiation-type cases. The 5-year local recurrence-free survival, metastasis-free survival, and disease-specific survival rates were 71.6%, 75.7%, and 84.7%, respectively. Among 32 patients with metastasis, 15 presented with extrapulmonary metastasis. A percentage of dedifferentiated area over 87.5%, marginal/intralesional margin, and R1/2 resection in the dedifferentiated area were independent risk factors for local recurrence. Dedifferentiated areas over 36 cm², French Federation of Cancer Centers Sarcoma Group grade III, and intralesional or marginal resection were independent risk factors for metastasis. A dedifferentiated area over 77 cm² and lung metastasis were independent risk factors for disease-specific mortality.

Conclusions: The typical clinical characteristics of dedifferentiated liposarcoma in the extremity and trunk wall were reconfirmed in the largest cohort ever. The evaluation of the dedifferentiated area in terms of grade, extension, and pathological margin, together with securing adequate surgical margins, was critical in the management of this entity.

Keywords: Dedifferentiated liposarcoma; Extremity; Prognosis; Sarcoma; Trunk wall.

Publication types

Multicenter Study

MeSH terms

East Asian People*
Extremities / pathology
Humans
Liposarcoma* / pathology
Retrospective Studies
Treatment Outcome