Undifferentiated pleomorphic sarcoma: Factors predictive of adverse outcomes

Daniel Winchester, Julia Lehman, Tiffany Tello, Nicolette Chimato, Thomas Hocker, Sunhee Kim, Joseph Chang, Jeffrey Markey, Sue S. Yom, William Ryan, Thaddeus Mully, David Hodge, Clark Otley, Sarah T. Arron

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Undifferentiated pleomorphic sarcoma (UPS) encompasses rare neoplasms that can arise either in the dermis or in the subfascial soft tissue. The behavior of UPS ranges from indolent to aggressive, but data predicting outcomes are limited. Objective: Identify predictors of poor outcomes by analyzing a large collection of UPS cases. Methods: We evaluated all available cases of UPS (including those termed atypical fibroxanthoma, malignant fibrous histiocytoma, pleomorphic dermal sarcoma, and subfascial UPS) across 3 tertiary care centers. Results: Among the 319 patients, 45 experienced recurrence, 33 experienced metastasis, and 96 died of any cause. Risk factors for recurrence were clinical tumor size larger than 5 cm and invasion beyond subcutaneous fat. Risk factors for distant metastases were tumor site, tumor size larger than 2 cm, invasion beyond subcutaneous fat, and lymphovascular invasion. Risk factors for overall mortality were age, immunosuppression, tumor size larger than 2 cm, and lymphovascular invasion. History of skin cancer was associated with a lower risk of recurrence and metastasis. Limitations: This was a retrospective study. Conclusions: Using the unbiased approach of pooling all UPS cases regardless of terminology, we identified clinical and histologic factors predicting poor outcomes. We propose subcategorization of UPS (into superficial versus deep UPS), which is consistent with the American Joint Committee on Cancer staging of soft-tissue sarcoma.

Original languageEnglish (US)
Pages (from-to)853-859
Number of pages7
JournalJournal of the American Academy of Dermatology
Issue number5
StatePublished - Nov 2018


  • atypical fibroxanthoma
  • malignant fibrous histiocytoma
  • pleomorphic dermal sarcoma
  • undifferentiated pleomorphic sarcoma

ASJC Scopus subject areas

  • Dermatology


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