Abstract
Background: The primary site of metastasis from extremity sarcomas is the lung. When patients with extremity sarcoma present with the disease in more than one site but not in the lung, the question of whether the disease is multifocal or metastatic is difficult to resolve.
Methods: We reviewed 1423 patients admitted with extremity sarcoma from 1982 through 1996. Patient demographics, primary site, other sites, local recurrence, distant metastasis, and survival were analyzed. Statistics were by Fischer exact test, χ2, Kaplan-Meier method, and log-rank test where appropriate.
Results: Sixteen (1%) patients were identified with multifocal disease out of 1423 patients with extremity sarcoma. There was no difference in sex, age, size, grade, depth, and margins between multifocal and unifocal disease. In a mean follow-up time of 57 months, 50% had local recurrence of primary tumor, 80% had distant metastasis, and only 30% were alive at the time of the analysis. Whereas 21% of all patients with solitary disease develop lung metastasis, 63% of patients with apparent multifocal disease develop lung metastasis. The 5-year disease-specific survival of patients with multifocal disease was not different from that of all patients presenting with metastatic disease to lung.
Conclusion: Whether multifocal disease exists or is merely a form of metastasis is unproven by this analysis, but the outcome is the same. Management algorithms should suggest treating patients with multifocal disease as if it is metastatic disease.
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References
Siegmund H. Lipoblastische Sarkomatose.Virchows Arch Pathol Anat 1934;293:458–63.
Ackerman LV. Multiple primary liposarcomas.Am J Pathol 1944;20:789–93.
Enzinger FM, Winslow DJ. Liposarcoma. A study of 103 cases.Virchows Arch Pathol Anat 1962;335:367–88.
Reszel PA, Soule EH, Coventry MB. Liposarcoma of the extremities and the limb girdles. A study of two hundred and twenty two cases.J Bone Joint Surg 1966;48:229–44.
Altho A, Larsen TE. A case of multifocal liposarcoma.Acta Orthop Scand 1992;63:98–9.
Enterline HT, Culberson JD, Rochlin DB, Brady LW. Liposarcoma: a clinical and pathological study of 53 cases.Cancer 1960;13:932–49.
Georgiades DE, Alcalais CB, Karabela VG. Multicentric well-differentiated liposarcomas.Cancer 1969;21:1091–7.
Shibata K, Koga Y, Hara T, et al. A primary liposarcoma of the mediastinum—A case report and review of the literature.Jpn J Surg 1986;16:277–83.
Silva DC, DeOliveira FS, Bevilacqua RG, et al. Multicentric myxoid, metachronous and synchronous multifocal liposarcoma: a case report.Rev Hosp Clin Fac Med Sao Paulo 1994;49:217–20.
Karakousis CP, Proimakis C, Walsh DL. Primary soft tissue sarcoma of the extremities in adults.Br J Surg 1995;82:1208–12.
Gadd MA, Casper ES, Woodruff JM, McCormack PM, Brennan MF. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma.Ann Surg 1993;218:705–12.
Chang HR, Hadju SI, Collin C, Brennan MF. The prognostic value of histologic subtypes in primary extremity liposarcoma.Cancer 1989;64:1514–20.
Vezeridis MP, Moore R, Karakousis CP. Metastatic patterns in soft tissue sarcomas.Arch Surg 1983;118:915–8.
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Blair, S.L., Lewis, J.J., Leung, D. et al. Multifocal extremity sarcoma: An uncommon and controversial entity. Annals of Surgical Oncology 5, 37–40 (1998). https://doi.org/10.1007/BF02303762
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DOI: https://doi.org/10.1007/BF02303762