Importance: Pleomorphic dermal sarcoma (PDS) is an aggressive cutaneous malignancy. Due to it's rarity, clinicopathologic prognostic factors are poorly defined and treatment factors may influence overall survival (OS).
Objective: To assess clinicopathologic prognostic factors associated with OS in PDS via an aggregated national dataset. Secondarily, to analyze differences in survival outcomes and treatment factors between head and neck (HN) and non-head and neck (non-HN) PDS.
Design, Setting, Participants: A retrospective review of all cases of PDS in the National Cancer Database was performed. All patients with PDS from 2004-2017 were selected. Data was analyzed from August 1, 2024 to October 15, 2024.
Main Outcomes and Measures: Clinicopathologic and treatment factors influencing overall survival.
Results: A total of 1,183 patients with PDS met inclusion criteria (79.4% male, mean age 74.5 +/- standard error (SE) 0.4). The median OS after diagnosis in patients with PDS was 6.3 years +/- 0.3. A statistically significant difference in survival was observed between HN PDS (Median OS: 6.5 years +/- 0.2) compared to non-HN PDS (8.1 years +/- 0.4). Other independent predictors of survival on univariate analysis included age, Charlson Deyo comorbidity score, grade, tumor size, margin status after surgical resection, adjuvant treatment and presence of distant metastasis. Only age, grade and treatment with adjuvant therapy were predictive of OS on multivariate regression analysis. On subset analysis, PDS in HN subsites presented in older patients (HN: 76.2 years +/- 0.4 vs. Non-HN: 67.6 years +/-1.1), had lower rates of being treated at a community hospital (61.1% in non-HN, 46.9% in HN population p<0.001), had longer time between diagnosis and treatment initiation (HN: 19.1 days +/- 1.1 vs. Non-HN: 12.2 days +/- 1.5 <0.001) and were less likely to receive adjuvant therapy (HN: 17.1% vs. Non-HN 24.2%, p =0.014) when compared to the patients with non-HN PDS.
Conclusion and Relevance: When accounting for other factors, OS in PDS is influenced by the patient's age, tumor grade and treatment modality. PDS in the HN region have a lower overall survival likely driven by older age at presentation and decreased rate of adjuvant therapy.