Background: To address the prognosis and the role of surgery in the management of patients with malignant fibrous histiocytoma (MFH), strict definition and accurate evaluation of local recurrence is mandated, together with adequate gross and microscopic evaluation of the achieved surgical margins.
Methods: One hundred and twenty-three patients with MFH were retrospectively analyzed regarding prognostic factors of the disease, which included the following: (1). primary or recurrent, (2). histological grade, (3). adjuvant chemotherapy, (4). size, (5). local recurrence after primary surgery done at the authors' institute, (6). adjuvant radiotherapy, and (7). surgical margin. Initially, all patients were metastasis-free (M0N0).
Results: Local recurrence after primary surgery done at the authors' institute was the most significant prognostic factor, where 20 of 123 patients developed local recurrence ( P < 0.0001). The cause of local recurrence were insufficient surgical margin in 16 patients, while in 4, local recurrences were related to lymph node metastasis, skip metastasis, and tumor embolism. The local recurrence rate for each surgical procedure was 75% for intralesional, 44.4% for marginal, 30.8% for inadequate wide, 12.3% for adequate wide, and 5% for curative procedures. In patients with a history of recurrent tumor or infiltrative pattern, local recurrence was not observed after a curative procedure, but occurred even after an adequate wide procedure.
Conclusion: To improve the prognosis of MFH, surgical prevention of local recurrence is essential. An adequate wide procedure for primary tumors and a curative procedure for recurrent tumors and tumors with an infiltrative pattern provide safe surgical margins.