Prognostic Significance of Proliferating Cell Nuclear Ant igen Exp ress ion in Soft Tissue Sarcomas of the Extremities

Abstract

We analysed 40 patients with soft tissue sarcomas (STS) of the extremities to investigate the prognostic significance of the growth fraction of the tumor. The patients consisted of 27 males and 13 females, and the ages ranged from 18 to 70 years (median 46.9 years). Tumors were located in the thigh (47. 5%), forearm (15%), buttock (10%), shoulder (10%), axilla (5%), arm (5%), lower leg (5%), and foot (2.5%) in a descending order of frequency. Histologically, malignant fibrous histiocytoma (25%) and liposarcoma (25%) were the most common types, followed by synovial sarcoma (17.5%), malignant schwannoma (10%), and rhabdomyosarcoma (5%). Local recurrence ranging from 1 to 4 times (average 1.7 times) was noted in 18 cases (45%). Distant metastasis was found in 5 out of 30 patients (16.7%), and the lung, liver, and abdominal wall were the predilection sites. Cumulative survival rates of all STS studied were 76% and 58% in 2 years and 5 years, respectively. Univariate analysis revealed that patient's age, surgical stage, histologic grade, differentiation of tumor cells, mitotic count, and proliferative index were related to survival. Among known parameters of histologic grading, only mitotic count was correlated with proliferative index. Multivariate analysis showed that patient's age, surgical stage and proliferative index were significant prognostic factors. This study indicates that the proliferative index using the antibody against proliferating cell nuclear antigen is useful to assess the prognosis of STS.