Malignant Fibrous Histiocytoma and Undifferentiated Pleomorphic Sarcoma A Retrospective Single-Center Analysis (1994–2022)

Background: Malignant Fibrous Histiocytoma (MFH), reclassified as undifferentiated pleomorphic sarcoma (UPS) in the 2013 World Health Organization (WHO) classification, is a high-grade pleomorphic sarcoma of mesenchymal origin. It is the most common soft-tissue sarcoma in late adulthood, predominantly affecting males aged 40-80. Surgical resection remains the cornerstone of treatment, while radiotherapy (RT) and chemotherapy (CT) are used selectively to improve local control and survival. This study evaluated the prognostic impact of surgical margin status and adjuvant treatments.Methods: This retrospective study evaluated 57 patients with MFH/UPS (31 males, 26 females) treated and followed between 1994 and 2022. All patients underwent surgical intervention, and those developing local recurrence were treated with second or third surgical procedures when feasible. Surgical margin status (R0, R1, R2) and its association with local recurrence and distant metastasis were analyzed.Results: Negative surgical margins (R0 resection) achieved during the initial surgery were strongly associated with improved local disease control. Positive surgical margins (R1/R2) were significantly associated with the development of lung metastases. Repeated surgeries and adjuvant therapies were insufficient to compensate for inadequate initial surgical margins.Conclusions: Achieving wide, margin-negative resection at the initial surgical intervention is the most critical determinant of oncologic outcome in MFH/UPS. While RT and CT may provide adjunctive benefits in selected cases, optimal surgical management remains the key factor for long-term disease control.