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ABSTRACT Background Pleomorphic liposarcoma (PLPS) is an ultra‐rare malignancy distinct from well‐differentiated/dedifferentiated and myxoid liposarcoma. In this study, we sought to (1) assess outcomes after surgery for primary, non‐metastatic PLPS and (2) explore potential indications for multimodality therapy. Methods Clinicopathologic data were retrospectively collected for patients treated from 2002 to 2019 at our sarcoma referral center. Descriptive data were summarized and Kaplan–Meier plots were constructed for overall survival (OS) and crude cumulative incidences (CCI) of disease‐specific death (DSD), local recurrence (LR), and distant metastasis (DM). Univariable models were performed to assess the association of specific variables of interest on outcome. Results Forty‐four pathology‐verified PLPS cases were included in this study. Median tumor size was 8.5 cm; 75% were FNCLCC Grade 3. All patients underwent complete resection, including 15 patients (34%) who required re‐excision to secure microscopic negative margins. Radiation therapy was given to 75% of patients, chemotherapy in 36%. At 5 years, OS was 75.3%; CCI of DSD, LR, and DM were 17.5%, 2.3%, and 32.5%. Larger tumor size was strongly associated with worse OS ( p = 0.028) and DSD ( p ≤ 0.001). A subgroup of patients ( n = 10, 23%) with smaller, predominantly Grade 2 tumors underwent surgery alone without any LR or DM event at a median follow‐up of 7.9 years. Conclusions In PLPS, aggressive surgery and when appropriate, radiation therapy, results in excellent local control. Chemotherapy can be considered for larger tumors. Patients with smaller, Grade 2 tumors may be potentially cured with surgery alone.
Tseng et al. (Fri,) studied this question.