Impact of unplanned surgery on prognosis of myxoid liposarcoma and analysis of salvage treatment strategies_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QU Guoxin ¹ , HOU Jingyu ¹ , SU Qilong ¹ , ZHANG Chunlei ¹ , WANG Jiaqiang ¹ , WANG Xin ¹ , ZHANG Peng ¹ , NIU Xiaohui ² ,  YAO Weitao ¹

1. Department of Bone and Soft Tissue, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou Henan, 450008, P. R. China;
2. Department of Osteo-Oncology, Capital Medical University Affiliated Beijing Jishuitan Hospital, Beijing, 100032, P. R. China;

Corresponding?author：

YAO Weitao, Email: zlyyyaoweitao1402@zzu.edu.cn

Keywords：

Myxoid liposarcoma; soft tissue sarcoma; unplanned surgery; extended resection

DOI：

10.7507/1002-1892.202512109

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Objective To compare the effectiveness of different treatment strategies after unplanned surgery for myxoid liposarcoma (MLS) and explore the clinical value of salvage therapy versus planned treatment following unplanned resection. Methods The clinical data of 37 MLS patients admitted between June 2014 and June 2024 who met the selection criteria were retrospectively analyzed. Patients were divided into three groups based on initial treatment status: the unplanned treatment group (group A, 14 cases, transferred after benign tumor excision without further treatment at external hospitals, presenting with local recurrence), the salvage planned treatment group (group B, 10 cases, transferred within 1 month after benign tumor excision at external hospitals), and the planned treatment group (group C, 13 cases, transferred without prior treatment or only after biopsy). No significant difference (P>0.05) was observed among the three groups in baseline characteristics including age, height, weight, and maximum preoperative tumor diameter. Tumor recurrence or metastasis time were recorded. Overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method with intergroup comparisons. Results All 37 patients were followed up 19-193 months (mean, 67.4 months). Group A exhibited higher tumor recurrence (28.6%) and metastasis rates (35.7%) than group B (10.0%, 10.0%) and group C (0, 23.1%), with significant differences in recurrence rates (P<0.05), no significant differences existed between groups B and C (P>0.05); metastasis rates showed no intergroup significance (P>0.05). Group A demonstrated lower 1-/3-/5-year DFS (71.4%, 42.9%, 21.4%) than group B (100%, 88.9%, 74.1%) and group C (92.3%, 83.9%, 71.9%), with significant differences (P<0.017), no significant difference existed between groups B and C (P>0.017); 3-/5-year OS showed no intergroup significance (P>0.05). Conclusion Patients with MLS should undergo standard extended resection and individualized adjuvant radiotherapy and chemotherapy as soon as possible after unplanned surgery to significantly reduce the local recurrence rate. In view of the high risk of extrapulmonary metastasis, a comprehensive preoperative assessment of metastasis is required.

Citation： QU Guoxin, HOU Jingyu, SU Qilong, ZHANG Chunlei, WANG Jiaqiang, WANG Xin, ZHANG Peng, NIU Xiaohui, YAO Weitao. Impact of unplanned surgery on prognosis of myxoid liposarcoma and analysis of salvage treatment strategies. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(6): 958-963. doi: 10.7507/1002-1892.202512109 Copy

1.	Lee ATJ, Thway K, Huang PH, et al. Clinical and molecular spectrum of liposarcoma. J Clin Oncol, 2018, 36(2): 151-159.
2.	Qu G, Zhang C, Tian Z, et al. Diagnosis and treatment of myxoid liposarcoma. Curr Treat Options Oncol, 2024, 25(10): 1289-1296.
3.	Saifuddin A, Andrei V, Rajakulasingam R, et al. Magnetic resonance imaging of trunk and extremity myxoid liposarcoma: diagnosis, staging, and response to treatment. Skeletal Radiol, 2021, 50(10): 1963-1980.
4.	Fletcher C, Bridge J, Hogendoorn P, et al. WHO classification of tumours editorial board: soft tissue and bone tumours. Lyon, France: IARC, 2020: 71-73.Fletcher C, Bridge J, Hogendoorn P, et al. WHO classification of tumours editorial board: soft tissue and bone tumours. Lyon, France: IARC, 2020: 71-73.
5.	Ho TP. Myxoid liposarcoma: How to stage and follow. Curr Treat Options Oncol, 2023, 24(4): 292-299.
6.	Baranov E, Black MA, Fletcher CDM, et al. Nuclear expression of DDIT3 distinguishes high-grade myxoid liposarcoma from other round cell sarcomas. Mod Pathol, 2021, 34(7): 1367-1372.
7.	Callegaro D, Miceli R, Bonvalot S, et al. Impact of perioperative chemotherapy and radiotherapy in patients with primary extremity soft tissue sarcoma: retrospective analysis across major histological subtypes and major reference centres. Eur J Cancer, 2018, 105: 19-27.
8.	Tuzzato G, Laranga R, Ostetto F, et al. Primary high-grade myxoid liposarcoma of the extremities: Prognostic factors and metastatic pattern. Cancers (Basel), 2022, 14(11): 2657. doi: 10.3390/cancers14112657.
9.	Fiore M, Grosso F, Lo vullo S, et al. Myxoid/round cell and pleomorphic liposarcomas: prognostic factors and survival in a series of patients treated at a single institution. Cancer, 2007, 109(12): 2522-2231.
10.	Pollack SM, Somaiah N, Araujo DM, et al. Clinical outcomes of patients with advanced synovial sarcoma or myxoid/round cell liposarcoma treated at major cancer centers in the United States. Cancer Med, 2020, 9(13): 4593-4602.
11.	中國臨床腫瘤學會指南工作委員會. 中國臨床腫瘤學會 (CSCO): 骨與軟組織腫瘤診療指南 (2024). 北京: 人民衛生出版社, 2024.
12.	Fromm J, Klein A, Mentrup F, et al. Unplanned resections of soft tissue sarcomas-necessity of re-resection? Cancers (Basel), 2024, 16(10): 1851. doi: 10.3390/cancers16101851.
13.	Chouliaras K, Patel N, Senehi R, et al. Impact of resection margin on outcomes in high-grade soft tissue sarcomas of the extremity—A USSC analysis. J Surg Oncol, 2021, 123(2): 479-488.
14.	Abaricia S, Hirbe AC. Diagnosis and treatment of myxoid liposarcomas: Histology matters. Curr Treat Options Oncol, 2018, 19(12): 64. doi: 10.1007/s11864-018-0590-5.
15.	Lansu J, Braam PM, van Werkhoven E, et al. A moderate dose of preoperative radiotherapy may improve resectability in myxoid liposarcoma. Eur J Surg Oncol, 2021, 47(10): 2633-2639.
16.	Nassif EF, Keung EZ, Thirasastr P, et al. Myxoid liposarcomas: Systemic treatment options. Curr Treat Options Oncol, 2023, 24(4): 274-291.
17.	Qu G, Tian Z, Wang J, et al. Preoperative sequential chemotherapy and hypofractionated radiotherapy combined with comprehensive surgical resection for high-risk soft tissue sarcomas: a retrospective study. Front Oncol, 2024, 14: 1423151. doi: 10.3389/fonc.2024.1423151.
18.	Oberoi S, Choy E, Chen YL, et al. Trimodality treatment of extremity soft tissue sarcoma: Where do we go now? Curr Treat Options Oncol, 2023, 24(4): 300-326.
19.	Ray-coquard I, Serre D, Reichardt P, et al. Options for treating different soft tissue sarcoma subtypes. Future Oncol, 2018, 14(10s): 25-49.
20.	Brinkmann EJ, Ahmed SK, Houdek MT. Extremity soft tissue sarcoma: Role of local control. Curr Treat Options Oncol, 2020, 21(2): 13. doi: 10.1007/s11864-020-0703-9.
21.	Alaggio R, Coffin CM, Weiss SW, et al. Liposarcomas in young patients: a study of 82 cases occurring in patients younger than 22 years of age. Am J Surg Pathol, 2009, 33(5): 645-658.
22.	Pearlstone DB, Pisters PW, Bold RJ, et al. Patterns of recurrence in extremity liposarcoma: implications for staging and follow-up. Cancer, 1999, 85(1): 85-92.
23.	Schwab JH, Boland P, Guo T, et al. Skeletal metastases in myxoid liposarcoma: an unusual pattern of distant spread. Ann Surg Oncol, 2007, 14(4): 1507-1514.
24.	von Mehren M, Kane JM, Agulnik M, et al. Soft Tissue Sarcoma, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2023, 20(7): 815-833.
25.	Haas RLM, Miah AB, Lepechoux C, et al. Preoperative radiotherapy for extremity soft tissue sarcoma; past, present and future perspectives on dose fractionation regimens and combined modality strategies. Radiother Oncol, 2016, 119(1): 14-21.
26.	Albertsmeier M, Rauch A, Roeder F, et al. External beam radiation therapy for resectable soft tissue sarcoma: A systematic review and meta-analysis. Ann Surg Oncol, 2018, 25(3): 754-767.
27.	Perera JR, Alfaraidy M, Ibe I, et al. Intermuscular extremity myxoid liposarcoma can be managed by marginal resection following neoadjuvant radiotherapy. Eur J Surg Oncol, 2023, 49(2): 362-367.
28.	Lansu J, Bovée JVMG, Braam P, et al. Dose reduction of preoperative radiotherapy in myxoid liposarcoma: A nonrandomized controlled trial. JAMA Oncol, 2021, 7(1): e205865. doi: 10.1001/jamaoncol.2020.5865.
29.	Kainhofer V, Smolle MA, Szkandera J, et al. The width of resection margins influences local recurrence in soft tissue sarcoma patients. Eur J Surg Oncol, 2016, 42(6): 899-906.
30.	Gundle KR, Kafchinski L, Gupta S, et al. Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. J Clin Oncol, 2018, 36(7): 704-709.

1. Lee ATJ, Thway K, Huang PH, et al. Clinical and molecular spectrum of liposarcoma. J Clin Oncol, 2018, 36(2): 151-159.
2. Qu G, Zhang C, Tian Z, et al. Diagnosis and treatment of myxoid liposarcoma. Curr Treat Options Oncol, 2024, 25(10): 1289-1296.
3. Saifuddin A, Andrei V, Rajakulasingam R, et al. Magnetic resonance imaging of trunk and extremity myxoid liposarcoma: diagnosis, staging, and response to treatment. Skeletal Radiol, 2021, 50(10): 1963-1980.
4. Fletcher C, Bridge J, Hogendoorn P, et al. WHO classification of tumours editorial board: soft tissue and bone tumours. Lyon, France: IARC, 2020: 71-73.Fletcher C, Bridge J, Hogendoorn P, et al. WHO classification of tumours editorial board: soft tissue and bone tumours. Lyon, France: IARC, 2020: 71-73.
5. Ho TP. Myxoid liposarcoma: How to stage and follow. Curr Treat Options Oncol, 2023, 24(4): 292-299.
6. Baranov E, Black MA, Fletcher CDM, et al. Nuclear expression of DDIT3 distinguishes high-grade myxoid liposarcoma from other round cell sarcomas. Mod Pathol, 2021, 34(7): 1367-1372.
7. Callegaro D, Miceli R, Bonvalot S, et al. Impact of perioperative chemotherapy and radiotherapy in patients with primary extremity soft tissue sarcoma: retrospective analysis across major histological subtypes and major reference centres. Eur J Cancer, 2018, 105: 19-27.
8. Tuzzato G, Laranga R, Ostetto F, et al. Primary high-grade myxoid liposarcoma of the extremities: Prognostic factors and metastatic pattern. Cancers (Basel), 2022, 14(11): 2657. doi: 10.3390/cancers14112657.
9. Fiore M, Grosso F, Lo vullo S, et al. Myxoid/round cell and pleomorphic liposarcomas: prognostic factors and survival in a series of patients treated at a single institution. Cancer, 2007, 109(12): 2522-2231.
10. Pollack SM, Somaiah N, Araujo DM, et al. Clinical outcomes of patients with advanced synovial sarcoma or myxoid/round cell liposarcoma treated at major cancer centers in the United States. Cancer Med, 2020, 9(13): 4593-4602.
11. 中國臨床腫瘤學會指南工作委員會. 中國臨床腫瘤學會 (CSCO): 骨與軟組織腫瘤診療指南 (2024). 北京: 人民衛生出版社, 2024.
12. Fromm J, Klein A, Mentrup F, et al. Unplanned resections of soft tissue sarcomas-necessity of re-resection? Cancers (Basel), 2024, 16(10): 1851. doi: 10.3390/cancers16101851.
13. Chouliaras K, Patel N, Senehi R, et al. Impact of resection margin on outcomes in high-grade soft tissue sarcomas of the extremity—A USSC analysis. J Surg Oncol, 2021, 123(2): 479-488.
14. Abaricia S, Hirbe AC. Diagnosis and treatment of myxoid liposarcomas: Histology matters. Curr Treat Options Oncol, 2018, 19(12): 64. doi: 10.1007/s11864-018-0590-5.
15. Lansu J, Braam PM, van Werkhoven E, et al. A moderate dose of preoperative radiotherapy may improve resectability in myxoid liposarcoma. Eur J Surg Oncol, 2021, 47(10): 2633-2639.
16. Nassif EF, Keung EZ, Thirasastr P, et al. Myxoid liposarcomas: Systemic treatment options. Curr Treat Options Oncol, 2023, 24(4): 274-291.
17. Qu G, Tian Z, Wang J, et al. Preoperative sequential chemotherapy and hypofractionated radiotherapy combined with comprehensive surgical resection for high-risk soft tissue sarcomas: a retrospective study. Front Oncol, 2024, 14: 1423151. doi: 10.3389/fonc.2024.1423151.
18. Oberoi S, Choy E, Chen YL, et al. Trimodality treatment of extremity soft tissue sarcoma: Where do we go now? Curr Treat Options Oncol, 2023, 24(4): 300-326.
19. Ray-coquard I, Serre D, Reichardt P, et al. Options for treating different soft tissue sarcoma subtypes. Future Oncol, 2018, 14(10s): 25-49.
20. Brinkmann EJ, Ahmed SK, Houdek MT. Extremity soft tissue sarcoma: Role of local control. Curr Treat Options Oncol, 2020, 21(2): 13. doi: 10.1007/s11864-020-0703-9.
21. Alaggio R, Coffin CM, Weiss SW, et al. Liposarcomas in young patients: a study of 82 cases occurring in patients younger than 22 years of age. Am J Surg Pathol, 2009, 33(5): 645-658.
22. Pearlstone DB, Pisters PW, Bold RJ, et al. Patterns of recurrence in extremity liposarcoma: implications for staging and follow-up. Cancer, 1999, 85(1): 85-92.
23. Schwab JH, Boland P, Guo T, et al. Skeletal metastases in myxoid liposarcoma: an unusual pattern of distant spread. Ann Surg Oncol, 2007, 14(4): 1507-1514.
24. von Mehren M, Kane JM, Agulnik M, et al. Soft Tissue Sarcoma, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2023, 20(7): 815-833.
25. Haas RLM, Miah AB, Lepechoux C, et al. Preoperative radiotherapy for extremity soft tissue sarcoma; past, present and future perspectives on dose fractionation regimens and combined modality strategies. Radiother Oncol, 2016, 119(1): 14-21.
26. Albertsmeier M, Rauch A, Roeder F, et al. External beam radiation therapy for resectable soft tissue sarcoma: A systematic review and meta-analysis. Ann Surg Oncol, 2018, 25(3): 754-767.
27. Perera JR, Alfaraidy M, Ibe I, et al. Intermuscular extremity myxoid liposarcoma can be managed by marginal resection following neoadjuvant radiotherapy. Eur J Surg Oncol, 2023, 49(2): 362-367.
28. Lansu J, Bovée JVMG, Braam P, et al. Dose reduction of preoperative radiotherapy in myxoid liposarcoma: A nonrandomized controlled trial. JAMA Oncol, 2021, 7(1): e205865. doi: 10.1001/jamaoncol.2020.5865.
29. Kainhofer V, Smolle MA, Szkandera J, et al. The width of resection margins influences local recurrence in soft tissue sarcoma patients. Eur J Surg Oncol, 2016, 42(6): 899-906.
30. Gundle KR, Kafchinski L, Gupta S, et al. Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. J Clin Oncol, 2018, 36(7): 704-709.

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