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Comment & Response
December 2016

Prognostic Factors of Survival in Dermatofibrosarcoma Protuberans

Author Affiliations
  • 1School of Medicine, Imperial College London, London, England
JAMA Dermatol. 2016;152(12):1398. doi:10.1001/jamadermatol.2016.3227

To the Editor We would like to thank Criscito et al1 for their study evaluating the prognostic factors of survival in patients with dermatofibrosarcoma protuberans (DFSP). The authors conclude that age at diagnosis, male sex, and tumor size are the most valuable predictors of survival.

However, we would like to urge caution when interpreting these results because the study was limited by the lack of comprehensive evaluation of the role of tumor characteristics. Although an association between larger tumor size and poorer survival outcome is established, other vital histological features related to the tumor morphology such as DNA aneuploidy, mitotic figures, and cellularity were not examined. Thus, we question the extent to which the prognostic value of tumor size can be attributed to these histological factors. Specifically, the presence of fibrosarcomatous progression indicates a more aggressive variant of DFSP that typically has poorer survival outcomes.2 Since the study relies on retrospective data that had histological confirmation of DFSP, accounting for these well-established factors was possible and would have eliminated the ensuing confounding effects.

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