• Matthias Peiper, David Zurakowski, Wolfram Trudo Knoefel, and Jakob R Izbicki.
• Klinik und Poliklinik für allgemain- und Viszeralchirurgie, Universitätsklinikum Düsseldorf, the Chirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf, Germany.
• Surgery. 2004 Jan 1; 135 (1): 59-66.

BackgroundMalignant fibrous histiocytoma (MFH) is the most common subtype of soft-tissue sarcoma. Detailed understanding of this tumor type may lead to improved therapeutic strategies.MethodsAn institutional review was performed on all patients with primary MFH of the extremities and trunk operated on between 1988 and 2000.ResultsNinety-seven patients with histologically confirmed MFH (G1, n=8; G2, n=25; G3, n=64) were analyzed. Local recurrence was 31% after a median of 13 months. Distant metastases occurred in 29 patients (30%). After a median follow-up of 4.5 years, 54 patients were alive without evidence of disease; median survival time was 84 months at a cumulative 5-year survival rate of 70%. Tumor size significantly influenced disease-free survival (T2 vs T1, P<.01, risk ratio [RR] 6.0), as did tumor depth (subfascial tumors, P<.01, RR 3.1) and presence of positive lymph nodes (P=.02, RR 6.9). Positive microscopic margins and subfascial tumors were associated with an increased local recurrence rate (RR 4.8, P<.001 and RR 3.5, P=.02, respectively). Significant multivariate risk factors of distant metastases were tumor size, depth, and grade. Though not performed in a randomized fashion, a subgroup analysis indicated that adjuvant radiation therapy significantly reduced local tumor failure.ConclusionWe conclude that aggressive, albeit limb-preserving resection of MFH, should be performed at initial operation to minimize risk of local recurrence; a strict follow-up especially of subfascial tumors should be performed.

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