Background

Mohs micrographic surgery or wide local excision is the treatment of choice for fibrohistiocytic tumors with metastatic potential, including atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS). Since margin clearance is the strongest predictor of clinical recurrence, improved recommendations for appropriate surgical margins help delineate uniform excision margins when intraoperative margin assessment is not available.

Objective

To determine appropriate surgical wide local excision margins for AFX and cUPS.

Methods

Literature search (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to March 2020) to detect case-level data. Estimation of margins required using a mathematical model based on extracted cases without recurrences.

Results

Probabilistic modeling based on 100 cases extracted from 37 studies showed peripheral clearance margin (ie, wide local excision margin) calculated to clear 95% of all tumors was 2 cm for AFX and 3 cm for cUPS. AFX tumors 1 cm or less required a margin of 1 cm.

Limitations

Data were extracted from published cases.

Conclusions

Atypical fibroxanthoma removed with at least a 2-cm peripheral excision margin is less likely to recur. Smaller tumors 1 cm or less can be treated with a more conservative margin. Margin-control surgical techniques are recommended to ensure complete removal while minimizing surgical morbidity.

中文翻译：

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纤维组织细胞肿瘤的手术切缘，包括非典型纤维黄色瘤和未分化多形性肉瘤：基于系统评价的概率模型

背景

Mohs 显微手术或广泛局部切除是具有转移潜力的纤维组织细胞肿瘤的首选治疗方法，包括非典型纤维黄色瘤 (AFX) 和皮肤未分化多形性肉瘤 (cUPS)。由于切缘清除是临床复发的最强预测因素，因此当术中切缘评估不可用时，改进的适当手术切缘建议有助于划定统一的切除切缘。

客观的

确定适用于 AFX 和 cUPS 的手术广泛局部切除边缘。

方法

文献检索（Ovid MEDLINE、Embase、Web of Science 和 Cochrane Library 从成立到 2020 年 3 月）以检测病例级数据。使用基于没有复发的提取案例的数学模型估计所需的边际。

结果

基于从 37 项研究中提取的 100 例病例的概率模型显示，经计算可清除 95% 的所有肿瘤的外周间隙边缘（即广泛的局部切除边缘）对于 AFX 为 2 cm，对于 cUPS 为 3 cm。1 cm 或更小的 AFX 肿瘤需要 1 cm 的边缘。

限制

数据是从已发表的案例中提取的。

结论

非典型纤维黄瘤切除至少 2 cm 外周切缘不太可能复发。1 cm 或更小的较小肿瘤可以用更保守的边缘进行治疗。建议使用边缘控制手术技术，以确保完全切除，同时最大限度地减少手术发病率。