Extremity Myxoid Liposarcoma: Prognostic Factors and 20-Year Survival Outcomes

Introduction: Myxoid liposarcoma (MLS) is a rare, malignant musculoskeletal tumour. Due to the rarity of MLS, the factors associated with survival remain only partially understood. The aim of this retrospective study was to identify prognostic factors in patients with extremity MLS treated at our centre. Methods: We reviewed the clinical records of 60 patients with extremity MLS treated at our hospital from 1997 to 2017. We evaluated patient- and tumour-related characteristics, as well as diagnostic and therapeutic procedures to determine their association with clinical outcomes, including local Recurrence-Free Survival (RFS), Metastasis-Free Survival (MFS) and Overall Survival (OS). Survival data were analyzed with the Kaplan-Meier method. Multivariate analyses were performed with Cox proportional-hazards regression. Results: Overall survival at 5 years was 91%. On the multivariate analysis, surgical margins were an independent risk factor for MFS (Hazard Ratio [HR]: 10.98, 95% Confidence Interval [CI]:2.59-46.46), local RFS (HR: 9.34, 95% CI: 1.75-49.68), and OS (HR: 27.90, 95% CI: 5.01–155.50) (all p=0.001). Revision surgery was significantly associated (p=0.001) with higher local recurrence rates (HR: 99.13, 95% CI: 6.90–1423). Conclusions: Surgical margins were an independent risk factor for MFS, local RFS, and OS. The need for revision surgery due to an unplanned excision was strongly associated with an increased risk of local recurrence, but not with MFS or OS. These findings underscore the importance of achieving clear surgical margins, especially in patients undergoing second-look surgery.