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Original Investigation |

Prognostic Factors, Treatment, and Survival in Dermatofibrosarcoma Protuberans ONLINE FIRST

Maressa C. Criscito, BS1; Kathryn J. Martires, MD1; Jennifer A. Stein, MD, PhD1
[+] Author Affiliations
1The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
JAMA Dermatol. Published online June 04, 2016. doi:10.1001/jamadermatol.2016.1886
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Importance  There is limited information regarding the influence of patient demographics, tumor characteristics, and treatment type on the survival of patients with dermatofibrosarcoma protuberans (DFSP).

Objective  To assess prognostic factors and to evaluate the influence of treatment modality on overall survival of patients with DFSP.

Design, Setting, and Participants  We examined DFSP using data for 3686 patients with histologically confirmed cases of DFSP diagnosed between 1972 and 2012 from the 18 US regional registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, with linkage to demographic data from the US Census Bureau for median household income (MHI). The analysis was performed in February 2016.

Main Outcomes and Measures  The primary outcome measures were tumor characteristics, prognostic factors, and overall survival in months.

Results  There were 3686 cases of DFSP examined. Older age (hazard ratio [HR], 1.08; 95% CI, 1.06-1.10; P < .001), male sex (HR, 1.97; 95% CI, 1.09-3.55; P = .03), and tumor size (HR, 1.09; 95% CI, 1.01-1.18; P = .04) were significantly associated with poorer overall survival in a controlled analysis. Older age (odds ratio [OR], 1.01; 95% CI, 1.00-1.02; P = .01), male sex (OR, 1.95; 95% CI, 1.57-2.42; P < .001), and black race (OR, 1.78; 95% CI, 1.37-2.32; P < .001) were associated with larger (≥3.0 cm) tumors at presentation. Treatment modality did not influence overall survival; however, differences in patient characteristics affected the treatment received. Older age at presentation (OR, 1.02; 95% CI, 1.01-1.03; P =.01), black race (OR, 1.82; 95% CI, 1.13-2.92; P = .01), large tumor size (OR, 1.15; 95% CI, 1.09-1.21; P < .001), and head or neck location (OR, 4.63; 95% CI, 2.66-8.07; P <.001) increased the likelihood of a patient receiving surgery and radiation over surgery alone. In addition, white patients (OR, 0.51; 95% CI, 0.30-0.87; P=.01), women (OR, 0.53; 95% CI, 0.36-0.78; P <.001), and patients with a higher MHI (OR, 1.27; 95% CI, 1.11-1.46; P <.001) were more likely to receive Mohs micrographic surgery (MMS) over excision.

Conclusions and Relevance  Age at diagnosis, male sex, and DFSP tumor size appear to be important prognostic factors. Treatment modality did not significantly influence survival; however, patient and tumor characteristics influence treatment modality.

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Figure.
Kaplan-Meier Curves of Prognostic Factors in Patients With Dermatofibrosarcoma Protuberans (DFSP)

A, As demonstrated in a Kaplan-Meier analysis with log-rank statistic, male patients had significantly worse survival than female patients. A controlled multivariable analysis also revealed that when compared with women, men with DFSP had almost twice the risk of death (hazard ratio [HR], 1.97; 95% CI, 1.09-3.55; P = .03). B, As demonstrated in a Kaplan-Meier analysis with log-rank statistic, patients with with small (<3.0 cm) DFSP tumors had greater survival than those with large (≥3.0 cm) tumors. A controlled multivariable analysis demonstrated that for every 1-cm increase in tumor size, a patient with DFSP had a 9.0% increased risk of death from all-cause mortality (HR, 1.09; 95% CI, 1.01-1.18; P = .04).

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