Novel predictors associated with therapeutic effects of immune checkpoint inhibitors on bone metastasis of non-small cell lung cancer

e21071

Background: In recent years, immune checkpoint inhibitors (ICIs) have brought dramatic therapeutic effects on lung cancer. However, there are few reports regarding the therapeutic effect of ICIs on bone metastasis of non-small cell lung cancer (NSCLC). The purpose of this study was to investigate the therapeutic effects of ICIs on bone metastases of NSCLC and to analyze the predictors associated with ICI's response to them. Methods: This retrospective study analyzed NSCLC with bone metastases who initiated ICI treatment between 2016 and 2019. Clinical data was investigated and used as variables for analyzing the therapeutic effect predictors of ICIs. Blood sampling data were used within 1 week before ICI treatment initiation. The therapeutic effect of ICIs on bone metastases was evaluated by MD Anderson criteria (MDA criteria), and overall survival (OS) after the initiation of ICI treatment was investigated. Based on the evaluation of MDA criteria, univariate analysis was performed between the response group (CR+PR) and non-response group (SD+PD), and variables with p < 0.05 were used for multivariate logistic regression analysis to investigate the predictors associated with the therapeutic effect of ICIs. Results: The 55 patients were included comprising 40 males and 15 females (mean age of 66.3±7.9 years) and the mean follow-up period was 23.2 months. The response rate of ICIs to bone metastasis was 30.9% including 3 cases in CR and 14 cases in PR. The median survival time was 9.3 months, and the 1-year and 2-year survival rates were 40.6% and 19.3%, respectively. The OS was significantly longer in the response group than in the non-response group (p < 0.01). In the blood sampling data, the cutoff value of neutrophil-to-lymphocyte ratio (NLR) determined by receiver operating characteristic (ROC) curve analysis was 2.1. The multivariate analysis based on the variables with p < 0.05 in the univariate analysis revealed significant differences in sex, treatment line of ICIs, and NLR (Table). Conclusions: Treatment with ICIs showed favorable responses to bone metastasis and better prognosis in advanced NSCLC. Moreover, this study revealed that “female, NLR < 2.1, and first-line treatment of ICIs” were independent predictors associated with favorable response to bone metastasis.[Table: see text]

Compartment-specific Clinical Outcomes in Patients With Soft Tissue Sarcomas of the Thigh

BACKGROUND/AIM

The thigh is divided into the anterior, medial, and posterior compartments, and malignant soft tissue tumours can occur in any compartment of the thigh. This study analysed the relationship between various factors, particularly tumour location and clinical outcome, in patients with primary soft tissue sarcoma of the thigh.

PATIENTS AND METHODS

Seventy-four patients were included in this retrospective study. The relationships between variables and prognosis were statistically analysed.

RESULTS

Multivariate analysis of the patient clinical data demonstrated that seromas developed more often in the medial compartment tumours and postoperative complications excluding seroma occurred more frequently in patients with two or more muscles resected or stage III tumours. A low Musculoskeletal Tumor Society score was associated with a long operative time (more than 120 min), anterior compartment tumours, and more than two muscle resections. In addition, soft tissue sarcomas in the medial compartment and stage III sarcomas were associated with a low 5-year metastasis-free survival.

CONCLUSION

Soft tissue sarcomas in the medial compartment were associated with postoperative seroma and metastasis, whereas sarcomas in the anterior compartment correlated with low postoperative function.

Clinical outcomes and life expectancy of patients with unplanned excisions of soft tissue sarcoma

e23554

Background: As soft tissue sarcomas are rare, it is not uncommon that soft tissue sarcoma excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. This study investigated the characteristics of unplanned excision and analyzed the recurrence, life expectancy, and proper treatment for unplanned excision. Methods: Patients who underwent unplanned excision at another institution followed by additional wide excision at our hospital from January 2002 to December 2018 were identified. Forty-two patients met our criteria. The relationships between variables and oncological outcomes were statistically analyzed. Results: The mean age was 57.3 years (15–85 years). Sixty-nine percent (29 in 42) of tumors was in the subcutaneous tissue. Six tumors were located in the upper extremity, 24 in the lower extremity, and 12 in the trunk. Surgical margin after additional wide excision was positive in 10 cases and negative in 32 cases. Pathological examination of specimen showed 34 of 42 cases (80.9%) had residual tumor after primary tumor excision. Fourteen patients (33.3%) required reconstructions. Of the 42 patients, one had both preoperative MRI and biopsy, while nine patients underwent MRI only. Among them, only one patient had enhanced MRI. Ten patients had chemotherapy while no patient had radiotherapy over the follow-up period. The mean tumor size was 5.3 cm (0.8-20 cm). The unplanned excisions were performed by orthopaedic surgeons in 18 cases, by general surgeons in eight, by plastic surgeons in seven, by other surgeons in four. Four primary surgeries (9.5%) were performed in a sarcoma center. On multivariate analysis, positive surgical margin (HR 4.04, 95% CI 1.57-10.4, p < 0.01) was significantly associated with lower 5-year recurrence-free survival. Conclusions: First, to reduce the number of cases of unplanned excision, it should be recognized that small, subcutaneous tumors may be malignant. Second, it is considered that the high recurrence rate with positive margins after additional wide excision might be due to failure to recognize the nature and extent of the tumor without enhanced MRI and biopsy before primary surgery. Finally, surgeons should be aware that positive margin at additional wide excision is an independent risk factor for local recurrence.[Table: see text]

Compartment-specific clinical outcomes in patients with soft tissue sarcomas of the thigh

e23549

Background: Approximately one-third of all soft tissue sarcomas develop in the thigh, and the risk factors for developing a complication after soft tissue sarcoma resection include the tumour’s location in the lower extremity. This study analysed the relationship between various factors, particularly tumour location and clinical outcome, in patients with primary soft tissue sarcoma of the thigh. Methods: Patients who underwent wide excision of soft tissue sarcomas of the thigh without metastasis at the time of the initial visit between January 2006 and March 2018 were included in the study. Seventy-four patients were included in this retrospective study. The relationships between variables and prognosis were statistically analysed. Results: The mean patient age was 58.7 years (10–86 years), the mean follow-up period was 75 months (24–173 months). A total of 37 tumours were predominantly located in the anterior compartment of the thigh, 17 in the medial compartment, and 20 in the posterior compartment. Multivariate analysis of the patient clinical data demonstrated that seromas developed more often in the medial compartment tumours and postoperative complications excluding seroma occurred more frequently in patients with two or more muscles resected or stage III tumours. A low Musculoskeletal Tumor Society score was associated with a long operative time (more than 120 min), anterior compartment tumours, and more than two muscle resections. In addition, soft tissue sarcomas in the medial compartment and stage III sarcomas were associated with a low 5-year metastasis-free survival. Conclusions: Soft tissue sarcomas in the medial compartment were associated with postoperative seroma and metastasis, whereas sarcomas in the anterior compartment correlated with low postoperative function. Surgeons should be aware of compartment-specific clinical outcomes in patients with soft tissue sarcomas of the thigh.[Table: see text]

Therapeutic effects and clinical outcomes of immune checkpoint inhibitors on bone metastases in lung cancer

e21118

Background: In recent years, advanced lung cancer patients who received immune checkpoint inhibitors (ICIs) reportedly had a more prolonged overall survival (OS) than those treated with conventional anticancer drugs. However, the therapeutic effect of ICIs on bone metastases remains unclear. The purpose of this study was to investigate the therapeutic effects of ICIs on advanced lung cancer with bone metastasis. Methods: This retrospective study included 58 lung cancer patients (42 men and 16 women; mean age, 66.2±7.8 years) who had been diagnosed with bone metastasis before the initiation of ICI treatment between 2016 and 2019, and the mean follow-up period was 23.2 months. The clinical data such as content of chemotherapy including the bone-modifying agent (BMA), skeletal-related events (SREs), and immune-related adverse events (irAEs) were investigated. The therapeutic effects of ICIs on the primary lung lesions and bone metastases were evaluated by the response evaluation criteria in solid tumors 1.1 (RECIST 1.1) and MD Anderson criteria, respectively. To assess the influence of ICI treatment on prognosis, OS from the diagnosis of bone metastases was compared to the prognostic prediction of Katagiri's score. Results: The most used ICI was pembrolizumab in 27 cases (46.6%). BMA was used in 38 cases (65.6%), and denosumab was used in 31 cases (81.6%). SREs and irAEs were observed in three cases (5.2%) and 13 cases (22.4%), respectively. In the primary lung lesions, the response rate (RR) and disease control rate (DCR) of ICIs were 14.3% and 38.1%, respectively, including one case in CR and 5 cases in PR. In the bone metastatic lesions, the RR and DCR were 38.6% and 75.0%, respectively, including 3 cases in CR and 14 cases in PR. In 17 cases that ICIs responded to bone metastases, nine cases were treated with pembrolizumab (52.9%), and all cases whose evaluations were CR had been treated with concomitant therapy of pembrolizumab and denosumab. The median survival time was 28.1 months and the 2-year OS rate was 51.7%. The 6-, 12-, and 24-month OS rates in this study were more favorable than the prognostic prediction of the Katagiri's score. Conclusions: ICI treatment showed favorable responses to bone metastases in NSCLC and better prognoses than conventional predictive prognosis. Particularly, pembrolizumab may be the most effective, and the therapeutic effect was enhanced by the concomitant use of denosumab.[Table: see text]

Dedifferentiated chondrosarcoma of the middle finger arising from a solitary enchondroma: A case report

BACKGROUND

Dedifferentiated chondrosarcoma (DDCS) accounts for 10% of all chondrosarcomas and has the poorest outcome, with a 5-year survival rate of 7%-25%. DDCS commonly occurs in the femur and pelvis, whereas DDCS of the finger is extremely rare. Furthermore, the histological findings of preexisting solitary enchondroma samples are important and valuable for diagnosing malignant transformations.

CASE SUMMARY

We report our experience with DDCS in the proximal phalanx of the left middle finger of an 87-year-old woman. She had undergone surgery for enchondroma, with curettage and artificial bone grafting, 11 years ago, in the same location. Several years after the primary surgery, the left middle finger gradually started to enlarge, and the growth speed increased in the past year. Plain radiographs showed an expansive osteolytic lesion with calcifications and residual grafting material. Owing to the suspicion of malignancy, we performed ray amputation. Histological findings revealed an abrupt transition between the low-grade chondrosarcoma and dedifferentiated sarcoma components. The dedifferentiated components showed the features of a high-grade undifferentiated pleomorphic sarcoma. The patient was diagnosed with DDCS arising from a preexisting enchondroma. She had no local recurrence or distant metastasis and died of pneumonia 6 years and 10 months after the second surgery.

CONCLUSION

The histological findings of a precursor lesion showed a typical enchondroma, suggesting that DDCS can arise from enchondroma.

The Therapeutic Effect and Clinical Outcome of Immune Checkpoint Inhibitors on Bone Metastasis in Advanced Non-Small-Cell Lung Cancer

Introduction

In advanced non-small-cell lung cancer (NSCLC), immune checkpoint inhibitors (ICIs) have been reported a better treatment outcome on primary lesions, however, the therapeutic effect on bone metastases has not been clarified. This study investigates the therapeutic effect of ICIs on bone metastases in advanced NSCLC.

Methods

The data of patients with advanced NSCLC, treated with ICIs from 2016 to 2019 at our hospital, were analyzed. The therapeutic effects of ICIs on primary lung and metastatic bone lesions, concomitant use of bone modifying agents (BMA), treatment outcomes, and frequency of immune-related adverse events (irAEs) and skeletal-related events (SREs) were investigated.

Results

A total of 29 patients were included (19 men and 10 women; mean age, 64.2 years). Among the ICIs, pembrolizumab was the most used (55.2%), and concomitant use of BMA was prevalent in 21 patients (zoledronic acid=1, denosumab=20). The therapeutic effect was partial response (PR) in 10.3% (n=3) on primary lung lesions by RECIST 1.1, complete response (CR) in 6.9% (n=2) and PR in 17.2% (n=5) on bone metastatic lesions by MDA criteria. ICIs suppressed the progression of bone metastasis in 21 cases (72.4%). All patients in CR and PR were treated with pembrolizumab and denosumab. SREs and irAEs were developed in 3.4% (n=1) and 20.7% (n=6), respectively. The median survival time after treatment with ICIs was 11.0 months. Concomitant therapy with ICIs and denosumab significantly prolonged the overall survival compared to ICI-only therapy (16.0 months vs. 2.5 months, p<0.01).

Conclusions

This study showed that treatment with ICIs may successfully suppress the progression of bone metastasis in advanced NSCLC. Pembrolizumab with denosumab had the highest therapeutic effect on both primary lung lesions and bone metastases. Systemic treatment with this combination and conservative treatment of bone metastasis could be one of the options in the treatment of advanced NSCLC.

Clinical characteristics of patients with undergoing unplanned excisions of malignant soft tissue tumors

INTRODUCTION

Malignant soft tissue tumors are rare tumors representing <1% of all malignancies. As these tumors are rare, it is not uncommon that malignant soft tissue tumor excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. The purpose of this study was to investigate the characteristics of patients with undergoing unplanned excisions. Risk factors for tumor recurrence and mortality in patients treated with unplanned excisions were also analyzed.

METHODS

Forty-nine patients who underwent unplanned excision at other hospitals and additional wide excision at our hospital between January 2002 and December 2018 were identified. Among them, 42 patients with follow-up for more than 1 year were included in this retrospective study. The relationships between sex, age, tumor depth, histological grade, location, size, surgical margin at additional wide excision, residual tumor, reconstruction, kind of hospital where the primary excision was done (sarcoma vs non-sarcoma center), preoperative examination, chemotherapy, radiation therapy, and oncological outcomes were statistically analyzed.

RESULTS

Mean patient age was 57.3 years (15-85 years) and the mean observation period was 72.5 months (14-181 months). This analysis showed 53.8% tumors that underwent unplanned excisions were small (<5 cm) and 70.7% tumors were superficial. Multivariate analysis revealed that a positive margin during additional wide excision was significantly associated with a lower 5-year LRFS (p < 0.01).

CONCLUSION

Most of the tumors underwent unplanned excisions were small (<5 cm) and superficial. Surgeons should be aware that a positive margin during additional wide excision is an independent risk factor for local recurrence.

Primary total knee arthroplasty assisted by computed tomography-free navigation for secondary knee osteoarthritis following massive calcium phosphate cement packing for distal femoral giant-cell bone tumor treatment: a case report

BACKGROUND

Giant cell tumor of bone (GCTB) is an intermediate tumor commonly arising from the epiphysis of the distal femur and proximal tibia. Standard GCTB treatment is joint-preserving surgery performed using thorough curettage and the filling of the cavity with allo-, auto-, polymethyl methacrylate (PMMA), or synthetic bone graft. Calcium phosphate cement (CPC) is an artificial bone substitute, which has the benefit of being able to adjust defects, consequently inducing immediate mechanical strength, and promoting biological healing. Secondary osteoarthritis may occur following GCTB treatment and may need additional surgery if severe. However, details regarding surgery for secondary osteoarthritis have not been fully elucidated. There are no reports on the use of total knee arthroplasty (TKA) for the treatment of secondary osteoarthritis following CPC packing. The insertion of an alignment rod is a standard procedure in TKA; however, it was difficult to perform in this case due to CPC. Therefore, we used a computed tomography (CT)-free navigation system to assist the distal femur cut. This study presents a knee joint secondary osteoarthritis case following CPC packing for GCTB curettage that was treated with standard TKA.

CASE PRESENTATION

A 67-year-old Japanese woman, who was previously diagnosed with left distal femur GCTB and was treated by curettage and CPC packing 7 years ago, complained of severe knee pain. Left knee joint plain radiography revealed Kellgren and Lawrence (K-L) grade 4 osteoarthritis without evidence of tumor recurrence. Therefore, she was scheduled for TKA. There are no reports on the cutting of a femoral condyle surface with massive CPC with accurate alignment. Because it is difficult to insert the alignment rod intramedullary and cut the femoral condyle with CPC, we planned CT-free navigation-guided surgery for accurate bone cutting using an oscillating tip saw system to prevent CPC cracks. We performed standard TKA without complications, as planned. Postoperative X-ray showed normal alignment. Knee Society Knee Score (KSKS) and Knee Society Function Score (KSFS) ameliorated from 27 and 29 to 64 and 68, respectively The patient can walk without a cane postoperatively.

CONCLUSION

There was no report about the surface TKA guided by CT-free navigation after primary GCT surgery with CPC. We believe that this case report will help in planning salvage surgery for secondary osteoarthritis after CPC packing.

Pretreatment Neutrophil Count and Platelet-lymphocyte Ratio as Predictors of Metastasis in Patients With Osteosarcoma

BACKGROUND/AIM

Systemic inflammation responses have been associated with cancer development, progression and metastasis. Little is known about the risk of metastasis based on inflammatory-based scores in patients with osteosarcoma.

PATIENTS AND METHODS

A total of 65 osteosarcoma patients without metastasis at presentation were enrolled in this retrospective study. All had been diagnosed histologically, and their laboratory data at the first visit were collected from medical records. The inflammation-based scores, tumor size, location, staging, pathological fracture, treatment methods, follow-up periods, and metastasis-free duration were evaluated.

RESULTS

A multivariate Cox regression analysis revealed that a high platelet-lymphocyte ratio (PLR) >116 [hazard ratio (HR)=3.8, 95% confidence interval =1.5-9.3; p<0.01], and neutrophil count (NC) ≤4,030/μl (HR=4.5, 95%CI=1.7-12.3; p<0.01), were independent risk factors significantly associated with metastasis of osteosarcoma patients.

CONCLUSION

The combination of a high PLR >116 and NC ≤4,030/μl before treatment was a useful inflammatory-based prognostic indicator for metastasis in patients with osteosarcoma.

Therapeutic Targets and Emerging Treatments in Advanced Chondrosarcoma

Due to resistance to standard anticancer agents, it is difficult to control the disease progression in patients with metastatic or unresectable chondrosarcoma. Novel therapeutic approaches, such as molecule-targeting drugs and immunotherapy, are required to improve clinical outcomes in patients with advanced chondrosarcoma. Recent studies have suggested several promising biomarkers and therapeutic targets for chondrosarcoma, including IDH1/2 and COL2A1. Several molecule-targeting agents and immunotherapies have shown favorable antitumor activity in clinical studies in patients with advanced chondrosarcomas. This review summarizes recent basic studies on biomarkers and molecular targets and recent clinical studies on the treatment of chondrosarcomas.

A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma

This study evaluated the diagnostic accuracy of clinical, radiological, and histopathological examinations for differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma, and aimed to develop a new combined scoring system for the preoperative diagnosis of ALT/WDLS. Eighty-nine lipomas and 56 ALT/WDLS were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated. Then, univariate and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, size (> 11 cm), thick septa (> 2 mm), enhancement of septa or nodular lesions, and lipoblasts were significantly different for the diagnosis of ALT/WDLS. We developed a combined scoring system based on the six predictive factors (total 0-16 points, the cutoff was 9 points). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve. This combined scoring system does not require special equipment and reagents such as fluorescence in situ hybridization (FISH), and anyone can use it easily in many medical institutions with high diagnostic accuracy.

Monostotic Fibrous Dysplasia in the Femur Strongly Expressing RANKL With Concomitant Osteoporotic Vertebral Compression Fracture: A Case Report

BACKGROUND/AIM

This study aimed to present a rare case of fibrous dysplasia (FD) in a healthy young adult man with a concomitant osteoporotic vertebral compression fracture. FD is a benign lesion of the bone characterized by replacement of the medullary component with fibro-osseous tissue that contains abnormally arranged trabeculae of immature woven bone. Recently it has been reported that several bone tumors including FD express the receptor activator of nuclear factor-kappa B (RANK) and its ligand (RANKL). Therefore, we hypothesized that FD contributed to osteoporosis, linked by the RANK-RANKL pathway of osteoclastogenesis.

CASE REPORT

We report the case of a healthy man with monostotic femoral fibrous dysplasia (FD) with concomitant 7 ^th thoracic vertebra compression fracture due to osteoporosis [young adult mean (YAM) was 79% in bone mineral density (BMD)]. After curettage of the FD, artificial bone grafting in the cavity, and administration of alendronate sodium, BMD improved considerably within 9 months. FD is a benign bone condition in which abnormal fibrous tissue replaces normal bone. The axis of the receptor activator of nuclear factor-kappa B (RANK) and its ligand (RANKL) has been implicated in osteoporosis pathogenesis. RANKL immunohistochemical staining was performed, and strong staining of stromal cells was observed compared to other FD cases that showed weak to moderate staining.

CONCLUSION

The presence of FD might have contributed to the low BMD due to the RANK-RANKL axis acting as osteoclastogenesis stimulator.

Impact of Tumor Growth Speed of Primary Lesions on the Clinical Outcomes of Appendicular Skeletal Metastases

BACKGROUND/AIM

This study aimed to investigate the clinical influence of the growth speed of primary lesions on appendicular skeletal metastases to provide an optimal treatment strategy for the metastases.

PATIENTS AND METHODS

Fifty-seven patients who underwent surgery for appendicular skeletal metastases between 2008 and 2020 were included. According to the growth speed of primary lesions, the patients were divided into the S group (slow-to-moderate, n=34) and the R group (rapid, n=23), and the outcomes were investigated.

RESULTS

The period from diagnosis of skeletal metastases to pathological fracture (PF) was shorter in the R group than in the S group (p=0.24). The overall survival of the S group was significantly better than that of the R group (p=0.02).

CONCLUSION

The appendicular skeletal metastases of the primary tumor with rapid growth speed have a high risk of PFs developed early from the diagnosis of skeletal metastases, and the prognosis may be poor.

Osteosarcoma Patient-derived Orthotopic Xenograft (PDOX) Models Used to Identify Novel and Effective Therapeutics: A Review

BACKGROUND/AIM

Recurrent osteosarcoma is recalcitrant with poor response rates to first-line chemotherapy due to heterogeneity and metastatic potential. This disease requires novel drug discovery and precision treatment.

MATERIALS AND METHODS

The osteosarcoma patient-derived orthotopic xenograft (PDOX) mouse model mimics the clinical disease and has identified effective clinically-approved drugs and experimental agents, especially drug combinations, that hold much clinical promise.

RESULTS

Effective treatment for drug-resistant osteosarcoma includes regorafenib, as monotherapy, and temozolomide-irinotecan, trabectedin-irinotecan, sorafenib-everolimus, sorafenib-palbociclib, and olaratumab-doxorubicin-cisplatinum, as combinations.

CONCLUSION

The PDOX model can be used to improve the outcome of osteosarcoma patients, including individualized, precision therapy.

Effectiveness of silicone-based resilient denture liners on the patient-reported chewing ability: A randomized controlled trial

PURPOSE

This randomized controlled trial (RCT) aimed to elucidate the effectiveness of silicone-based resilient denture liners on perceived chewing ability.

METHODS

The RCT included completely edentulous patients on both the maxilla and mandible, who were willing to fabricate a new set of complete dentures. A random permuted block method (block size: 4) was used to assign groups to receive maxilla conventional complete denture and mandibular with either a conventional complete denture (CD) or complete demure relined with silicone-based resilient denture liner (RD). The patient-reported chewing ability of six foods, soybean curd, fish sausage, soybean sprout, cubic rice cracker, hard rice cracker, and dry squid, on a 100-mm visual analog scale was measured and reported at the final adjustment and three months after the final adjustment. Mann-Whitney U test was used to analyze the differences between the CD and RD (p < 0.05).

RESULTS

Edentulous patients wearing mandibular complete denture with RD had a higher patient-reported chewing ability than those wearing a CD, but the fish sausage did not in the RD three months after the final adjustment. It also took three months for the patient-reported masticatory ability to improve for cubic rice crackers, hard rice crackers, and dry squid and to show a difference between the RD and CD groups.

CONCLUSION

Although limited to some food types, mandibular complete dentures relined with silicone-based liners improved patient-reported chewing ability.

Multikinase-Inhibitor Screening in Drug-resistant Osteosarcoma Patient-derived Orthotopic Xenograft Mouse Models Identifies the Clinical Potential of Regorafenib

BACKGROUND/AIM

Osteosarcoma is a recalcitrant heterogenous malignancy. The aim of the present study was to compare a series of multikinase inhibitors (MKIs) for efficacy on two drug-resistant osteosarcoma patient-derived orthotopic xenograft (PDOX) models in order to identify a clinical candidate.

MATERIALS AND METHODS

The two osteosarcoma PDOX models were tested for response to the following MKIs: pazopanib, sunitinib, sorafenib, crizotinib, and regorafenib, in comparison to first-line treatment with cisplatinum and an untreated control.

RESULTS

Regorafenib led to regression of osteosarcoma in both PDOXs. Total necrosis was observed pathologically in the regorafenib-treated tumors. Sorafenib arrested growth, without inducing regression, in one osteosarcoma model but not the other, and the other MKIs only slowed tumor growth.

CONCLUSION

The present study demonstrated that regorafenib is much more effective than the other MKIs tested and has clinical potential against recalcitrant osteosarcoma.

Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults

Age affects the clinical outcomes of cancer treatment, including those for bone sarcoma. Successful reconstruction using frozen autograft after excision of bone sarcoma has been reported; however, little is known about the clinical outcomes of frozen autograft reconstruction according to age. The purpose was to evaluate the clinical outcomes of the frozen autograft reconstruction focusing on skeletally mature adolescents and young adults (AYAs) that was 15 to 39 years of age. A total of 37 AYA patients with primary bone sarcoma on the appendicular skeleton were enrolled in this study. The mean follow-up period was 89 months. The graft survival (GS), overall survival (OS), recurrence-free survival (RFS), complications and the function were retrospectively evaluated using medical records. The 10-year GS, OS, and RFS rates were 76%, 84%, and 79%, respectively. Bone union was achieved with a rate of 94% within 1 year after surgery, and nonunion (n = 1) and fracture (n = 2) were infrequently observed. Graft removal was performed in 7 cases, and the most common reason for the removal was infection (n = 5). The Musculoskeletal Tumor Society score was excellent in 23 cases of the available 29 cases. Frozen autograft reconstruction for AYAs showed excellent clinical outcomes, although the long-term follow-up is required.

Evaluation of locomotive syndrome in patients receiving surgical treatment for degenerative musculoskeletal diseases: A multicentre prospective study using the new criteria

OBJECTIVES

This study aimed to evaluate the condition of patients with locomotive syndrome (LS) and their improvement after undergoing surgery for degenerative musculoskeletal diseases using the new criteria, including stage 3.

METHODS

In total, 435 patients aged ≥40 years (167 middle-aged and 268 older) were divided into four groups based on the disease location: the lumbar (n = 118), hip (n = 191), knee (n = 80), and foot and ankle (n = 46) groups. Patients were evaluated by pre- and 1 year postoperative LS risk tests, including the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale.

RESULTS

The pre- and postoperative prevalence of LS stage 3 were 78% and 29%, respectively. The postoperative LS stage improved in 62% of patients (77% and 53% in the middle-aged and older groups, respectively). Overall, the knee group showed the worst results, and the foot and ankle groups showed the best pre- and postoperative results. The pre- and postoperative prevalence of LS stage 3 according to the 25-Question Geriatric Locomotive Function Scale were comparable to those based on the total assessment.

CONCLUSIONS

The new LS stage criteria are appropriate, and the 25-Question Geriatric Locomotive Function Scale is a good option for evaluating patients requiring surgery.

A Radiological Scoring System for Differentiation between Enchondroma and Chondrosarcoma

Simple Summary

Background: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. Methods: To evaluate the diagnostic usefulness of radiological findings for differentiation between enchondromas and chondrosarcomas, correlations between various radiological findings and final diagnoses were investigated. Based on the correlations, a scoring system combining these findings was developed. Results: In a cohort of 81 patients, periosteal reaction on X-ray, endosteal scalloping and cortical defect on CT, extraskeletal mass, multilobular lesion, abnormal signal in adjacent tissue on MRI, and increased uptake in bone scan and thallium scan was significantly correlated with final diagnoses. Based on the correlations, a radiological scoring system combining radiological findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and chondrosarcomas were 88%, 89%, and 88%, respectively. Conclusion: Comprehensive assessment combining radiological findings is recommended to differentiate between enchondromas and ACTs/chondrosarcomas.

Abstract

Background: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. In this study, correlations between radiological findings and final diagnosis were investigated in patients with central cartilaginous tumors. Methods: To evaluate the diagnostic usefulness of radiological findings, correlations between various radiological findings and final diagnoses were investigated in a cohort of 81 patients. Furthermore, a new radiological scoring system was developed by combining radiological findings. Results: Periosteal reaction on X-ray (p = 0.025), endosteal scalloping (p = 0.010) and cortical defect (p = 0.002) on CT, extraskeletal mass (p < 0.001), multilobular lesion (p < 0.001), abnormal signal in adjacent tissue (p = 0.004) on MRI, and increased uptake in bone scan (p = 0.002) and thallium scan (p = 0.027) was significantly correlated with final diagnoses. Based on the correlations between each radiological finding and postoperative histological diagnosis, a radiological scoring system combining these findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and ACTs/chondrosarcomas were 88%, 89%, and 88%, respectively (p = 0.003). Conclusion: Radiological assessment with combined radiological findings is recommended to differentiate between enchondromas and ACT/chondrosarcomas.

Delayed Initiation of Treatment Is Associated With Metastasis of Malignant Bone Tumor

BACKGROUND/AIM

The delayed initiation of treatment is not associated with good clinical outcomes in patients with malignancies. However, few previous studies have examined prognostic factors, including the delayed initiation of treatment, in malignant bone tumors.

PATIENTS AND METHODS

One hundred and one patients with malignant bone tumors were enrolled. Univariate and multivariate analyses were performed to identify factors predicting metastasis, including factors that delay the initiation of treatment.

RESULTS

The multivariate analysis revealed that high-grade bone malignancy (p<0.01), a >30-day delay in referral to a specialized hospital by a general practitioner (p=0.03), and large tumor size (>77 mm) (p=0.04), were independently associated with metastasis of malignant bone tumors.

CONCLUSION

When general practitioners notice a patient with a >77 mm bone tumor, early referral to a specialized hospital within one month might be essential for preventing metastasis.

Significant Improvement After Surgery for a Symptomatic Osteoblastoma in a Patient with Camurati-Engelmann Disease: Case Report and Literature Review

Camurati-Engelmann disease (CED) is a rare, progressive diaphyseal dysplasia characterized as diaphyseal hyperostosis and sclerosis of the long bones. Corticosteroids, bisphosphonates, and losartan have been reported to be effective systemic medications used to reduce CED symptoms. There are no reports of osteoblastoma in patients with CED, and osteoblastoma in the distal radius is rare. We present a patient diagnosed with CED, based on radiological and histological examinations, at 11 years old. At 22 years old, she experienced severe pain in her right forearm and was treated with bisphosphonate, losartan, and prednisolone; however, the pain continued. An expansive and sclerotic lesion at the distal radius was observed on radiography. A follow-up plain radiograph indicated that the lesion was growing. Fluorodeoxyglucose positron emission tomography revealed solitary, intense radiotracer uptake, and a biopsy and surgical resection were performed due to suspected malignancy. Pathologic analysis showed anastomosing bony trabeculae rimmed by osteoblasts observed in a loose fibrovascular stroma. The lesion was diagnosed as an osteoblastoma. Following bone excision and artificial bone grafting, the patient's severe pain almost completely disappeared. At final follow-up, no evidence of osteoblastoma recurrence was noted. To our knowledge, this is the first case report of osteoblastoma arising in a patient with CED. Bone excision and artificial bone grafting may be a treatment option for local symptomatic osteoblastoma in patients with CED.

[The oral function of community-dwelling older adults complaining of an oral function deterioration: An examination using the oral function-related items of the Questionnaire for Latter-stage Elderly People]

AIM

The oral function-related items of the newly developed "Questionnaire for Latter-stage Elderly People" are based on two items of the Kihon checklist assessing the masticatory and swallowing functions. In this study, we estimated the questionnaire's application rate and investigated the oral function of the respondents.

METHODS

Included were 699 older adults (274 men/425 women, average age, 73.4±6.6 years old). Those who responded positively to the related items were considered to have decreased swallowing and masticatory functions. The specific oral function was assessed based on the number of present and functional teeth; oral hygiene; oral moisture; occlusal force; oral diadochokinesis /pa/, /ta/, /ka/; tongue pressure; mixing ability; shearing ability; and Eating Assessment Tool (EAT)-10 (reference, score ≥3).

RESULTS

The rates of decreased masticatory and swallowing functions were 21.5% and 26.6%, respectively, while 7.4% of participants had both. Those with a decreased masticatory function showed fewer present teeth; a lower occlusal force, oral diadochokinesis /pa/, mixing ability, shearing ability, and higher EAT-10 scores.Those with a decreased swallowing function only had higher EAT-10 scores. In the early- and latter-stage elderly, the decreased masticatory function rates were 15.6% and 29.4%, respectively, the decreased swallowing function rates were 27.8% and 25.0%, respectively, and the rates of both decreased masticatory and swallowing functions were 6.0% and 9.5%, respectively.

CONCLUSION

The older adults who responded positively to the related questionnaire items, especially for items related to masticatory function, had a decreased oral function in multiple respects. The items related to the oral function in the Questionnaire for Latter-stage Elderly People are considered useful for identifying older adults with a decreased oral function.

Osteosarcoma-Derived Small Extracellular Vesicles Enhance Tumor Metastasis and Suppress Osteoclastogenesis by miR-146a-5p

Osteosarcoma is the most frequent type of primary bone tumor in children and adolescents, thus care for patients with malignant osteosarcoma is strongly required. The roles of small extracellular vesicles (SEVs) in enhancing metastases have been demonstrated in multiple tumors, but they are still poorly understood in osteosarcoma. Hence, this study investigated the effects of SEVs on progression and the tumor microenvironment in mice and patients. In an orthotopic implantation study, we found that osteosarcoma-derived SEVs had the potential to enhance metastases and angiogenesis. In addition, osteosarcoma-derived SEVs decreased the number of mature osteoclasts in vivo. In vitro osteoclastogenesis studies revealed that the inhibition of osteoclast maturation by osteosarcoma-derived SEVs was mediated by suppressing the NF-κB signal pathway. MicroRNA analysis of SEVs from different malignant human osteosarcomas revealed that miR-146a-5p was involved in the inhibition of osteoclastogenesis. In osteosarcoma patients, lower numbers of osteoclasts in biopsy specimens at the first visits were correlated with higher malignancy. These findings indicated that osteosarcoma-derived SEVs enhance distant metastasis of osteosarcomas by inhibiting osteoclast maturation, which may be a useful prognostic marker. This diagnostic method may enable to predict malignancy at early stage, and help to provide optimal care to patients with risk of high malignancy.