Musculoskeletal Oncology Service, National Cancer Center Hospital Musculoskeletal Oncology Service,...

Musculoskeletal Oncology Service, National Cancer Center Hospital

Musculoskeletal Oncology Service, Keio University Hospital

An Analysis of Clinicopathological Factors Related to the Tail-like Pattern of

Myxofibrosarcoma on MRI

Kazutaka Kikuta1, 2, 3, Daisuke Kubota1,

Akihiko Yoshida3, Hideo Morioka2,

Yoshiaki Toyama2, Hirokazu Chuman1, Akira Kawai1

1, Divison of Orthopedic Surgery, National Cancer Center Hospital

2, Department of Orthopedic Surgery, Keio University School of Medicine

3, Division of Diagnostic Pathology, National Cancer Center Hospital

Tail-like pattern of myxofibrosarcoma

October, 15-18th, 2014 InterContinental Berlin Hotel Berlin, Germany

Superficial location is significantly correlated to the tail-like pattern on MRI



Tail–like pattern Gd MRI

Superficial layer





The 2014 CTOS Annual Meeting

Conflict of Interest (COI)

Presentator: Kazutaka Kikuta

The authors have no conflict of interest to disclose with respect to this presentation



Backgrounds





Myxofibrosarcoma (MFS)

►Most often affects the extremities of the elderly

►The number of patients will increase due to the aging society

►High recurrence rate even after wide resection: 50-60 %





If It Recurs…

Amputation or death due to metastasis





Tail-like Pattern

Tail (+)

Tail (+)



What is the relationship between the tail-like pattern and clinical factors?

Gd MRI



Purpose of This Study

To identify clinical factorsrelated to the tail-like pattern on MRI





Materials and Methods





Materials

50 patients (1999-2008, National Cancer Center)

►Confirmed as MFS by a certified pathologist

►MRI reviewed by a certified radiologist





Clinical Variables►Tail-like pattern (+) or (-)

►Age at surgery (60≦or 60>)

►Gender

　　► Size (5cm ≦or 5cm>)

►Site (Extremity or Trunk)

►Location (Subcutaneous or deep)

►Histological grade (G1 or G2+G3)

►5-year recurrence free survival (5-year RFS)

►5-year disease free survival (5-year DFS)



Chi-square testP<0.01

Log-rank testP<0.01



Different Patterns on Gd MRI

Tail-like pattern Solid pattern Tail (-)Tail (+)





(Kikuta K, et al. 2014)

Results





Analysis of Clinical Data



Average age: 64.1y (23 – 97y)

Follow-up period: 1-154 months(Median: 62 m, Mean: 56.4 m)

Recurrence: 9/ 50 patients

Oncological outcomeCDF : 31 patientsNED : 11 patientsAWD : 4 patientsDOD : 4 patients

Metastasis: 6 patients

NumbersMRI status

Tail- like pattern 32Solid pattern 18

Age at surgery60≦ 3860> 12

GenderMale 32

Female 18Site

Extremity 35Trunk 15

LocationSuperficial 24

Deep 26Size

5cm≦ 405cm> 10

Histological gradeG1 29

G2+G3 13

Variables



The 5-Year RFS and DFS of All 50 Patients



5-year RFS 5-year DFS

80 % 68.9 %




IIHC Protein X 200x



Superficial location was significantly correlated to the tail-like pattern

Solid pattern Tail - like pattern χ 2Age at surgery 0.049

<60 4 860≦ 14 24

Gender 0.102M 11 21F 7 11

Size 0.0085cm> 0 105cm≦ 18 22

Depth 0.0009Subcutaneous 3 21

Deep 15 11Site 0.068

Extremity 13 22Trunk 5 10

Grade 0.319G1 7 22

G2+G3 4 9

Variables






MFS with the tail-like pattern Poorer prognosis




Discussion





Tail (+)

Tail (+)



Tail-like pattern is most obvious on Gd MRI

No research regarding the relationship between the tail-like pattern and clinical factors

Gd MRI



(Kaya M, et al. 2008)

Tail-like Pattern poor prognosis?



(Manoso MW, et al. 2006)

Tail-like pattern

High local recurrence rate

High invasive activity



Tail-like pattern is more prevalent in the superficial layer

Tail-like pattern



(Mentzel T, et al. 1996)

Superficial

Deep Solid pattern



The tumor with a Tail-like Pattern lead to Poorer Prognosis







Conclusions





Conclusions

►This study identified the significant relationship

between the tail-like pattern and

superficial location.

►MFS with the tail-like pattern had worse prognosis.

►Further studies are warranted to elucidate the

biological nature of the tail-like pattern of MFS.





Danke für deine Aufmerksamkeit!!





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