Prognostic Factors of Burke et al for Primary Sarcomas of the Heart

 

75 primary cardiac sarcomas studied:

(1) angiosarcomas: 26

(2) undifferentiated sarcomas: 18

(3) osteosarcomas: 9

(4) fibrosarcomas: 6

(5) malignant fibrous histiocytoma: 6

(6) leiomyosarcoma: 4

(7) myxosarcoma: 3

(8) synovial sarcoma: 2

(9) neurofibrosarcoma: 1

 

Overall survival is poor, with most patients (about 80%) dying by 1 year (median 6 months, mean 11 months). Survival to 5 years was rare.

 

Factors from multivariate analysis for survival at 1 year:

(1) mitotic rate: mitoses per high powered field in most mitotically active areas

(2) therapy: chemotherapy and/or radiation therapy

Factor	Finding	Odds Ratio	p value
mitotic rate	< 10 vs >= 10	infinite	0.01
therapy	any vs none	24.5	0.01

after Table 4, page 391

 

where:

• The mitotic rate in the table is < 10 and > 10. A rate equal to 10 is not given. I have assigned it as a poor prognostic indicator. However, since the authors studied groups with < 5, 5-10 and > 10 mitoses, there would be an argument for making it <= 10.

• Grading of sarcomas is usually based on mitotic activity, amount of necrosis, and differentiation towards an identifiable tissue type. A sarcoma with low mitotic rate and no necrosis would be low grade, while a sarcoma with a high mitotic rate and extensive necrosis would be high grade.

 

Favorable factors (see Figure 6, page 392):

(1) absence of necrosis

(2) left-sided tumors

(3) mitotic rates < 5 per high power field did better than those with 5 – 10 per HPF, which did better than those with > 10 mitoses per HPF

(4) any therapy (radiation and/or chemotherapy)

(5) complete resection vs partial resection vs unresectable

(6) no metastasis

 

where:

• Features associated with left-sided tumors: tended to be more indolent; included fewer angiosarcomas, which tended to be right sided; left-sided tumors might be discovered earlier; might be easier to resect.

• I am not sure which patients were selected for therapy, or if there was bias away from unresectable tumors.

 

Factors not affecting prognosis:

(1) age or gender

(2) tissue differentiation (differentiated = angiosarcoma, leiomyosarcoma, fibrosarcoma, osteosarcoma)

(3) histologic type