DOI: 10.1097/dss.0000000000004536 ISSN: 1076-0512

Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: A Retrospective Review and Survival Analysis at a Single Academic Institution

Michael Franzetti, Landon Hendrickson, Thomas Knackstedt, Lindsey Collins
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BACKGROUND

Prognostication of atypical spindle cell neoplasms, including atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS), is challenging; outcomes vary widely, and further identification of prognostic features is crucial.

OBJECTIVE

To evaluate prognostic factors that may portend worse outcomes in patients with AFX and PDS.

MATERIALS AND METHODS

A retrospective chart review of patients with AFX and PDS was conducted. Data were analyzed using Pearson chi square and T-test. Survival was analyzed using the Kaplan–Meier estimate. A stepwise cox proportional hazards model was created to identify variables associated with increased risk of poor outcomes.

RESULTS

Thirty-four patients with AFX and 10 patients with PDS were identified. PDS had a 60% overall mortality rate (vs 26.5% in AFX), a larger preoperative size of 8.9 cm2 (vs 2.4 cm2) (p < .0001), and a 50% recurrence rate (vs 5.9%) (p = .0039). Female gender (HR 22.18 95% CI 2.54–194.13; p = .001), immunosuppression (HR 5.02 95% CI 1.32–19.12; p = .0044), and perineural invasion (PNI) (HR 78.46 3.97–1,549.56; p = .0091) were associated with increased risk of poor outcomes.

CONCLUSION

Few large studies have examined clinical features that portend worse outcomes. The authors identify female gender, immunosuppression, and PNI as variables associated with increased risk of recurrence or death.

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