How much is enough? Defining the critical resection margin in myxofibrosarcoma

Myxofibrosarcoma (MFS) is characterized by infiltrative growth and high local recurrence (LR) rates. Despite consensus on the importance of negative resection margins (R0), the prognostic significance of quantitative margin width beyond R0 status remains unclear.

This single-center retrospective study included 94 patients with histologically confirmed myxofibrosarcoma treated between 2000 and 2023. Resection margins, recurrence patterns, and treatment variables were analyzed using descriptive stratification, exploratory threshold scanning with multiplicity correction, and complementary computational approaches for internal signal exploration.

Local recurrence occurred in 28/84 patients (33%; 28/79, 35% among those with documented recurrence status). Numeric margin width was available in 38/84 cases (45%). Exploratory threshold analyses showed the smallest unadjusted signal near 0.3 mm, but this finding did not remain consistently significant after multiplicity correction. Radiotherapy was associated with numerically lower recurrence rates, although subgroup comparisons remained non-significant and vulnerable to confounding by indication. Complementary computational analyses yielded overlapping margin-related signals, but all such findings were interpreted as exploratory given the limited sample size, sparse events, and lack of external validation.

In this exploratory analysis, very close resection margins may define a higher-risk zone for local recurrence, but the observed signal near 0.3 mm should not be interpreted as a clinically established threshold. R0 status ("tumor not on ink") and anatomical barrier quality remain the primary determinants of margin adequacy in myxofibrosarcoma. Prospective multicenter validation with standardized pathology and harmonized time-to-event data is required.