Background: Pleomorphic liposarcoma is an aggressive soft tissue sarcoma. Although surgery remains the only potentially curative therapy, there is ongoing debate about the significance of surgical margins on survival. Prior studies, including the largest to date, have not shown a correlation between microscopic tumor after resection and overall survival. The aim of this study was to determine if surgical resection margins are associated with long-term survival.

Methods: From 1995 to 2015, 39 patients with pleomorphic liposarcoma were treated at the UCLA Sarcoma Program. The prospectively maintained UCLA Sarcoma Database was used to identify histologically confirmed pleomorphic liposarcoma and long-term follow-up was obtained. Clinical, pathologic and treatment variables were analyzed for survival. Overall survival (OS) was calculated from date of surgery to death or last follow-up.

Results: Median follow-up time for all patients was 8.52 years. Median age was 62 years (range 22-88 years). Tumor location included: 72% extremity (lower 44%, upper 26%), trunk (18%), and retroperitoneum (10%). Median tumor size was 10 cm (range 1.5 to 25 cm). Patients treated with chemotherapy did not demonstrate improved survival (HR 1.97, CI 0.59-6.54). The median overall survival for patients with an R0 resection was 10.14 years compared to 4.27 years for patients with an R1 resection (HR 2.95, CI 1.04 to 8.35).

Conclusions: Negative surgical margins correlate with improved long-term (>10 year) survival in patents with primary pleomorphic liposarcoma. This underscores the importance of proper sarcoma surgery in the setting of primary disease in this rare histologic subtype.